To determine the effect of retained donor Descemet’s membrane (DM) on visual outcomes, contrast sensitivity, higher-order aberrations, and central graft thickness following deep anterior lamellar keratoplasty (DALK) using the big-bubble technique.

In this retrospective comparative study, keratoconic eyes undergoing DALK with the big-bubble technique were enrolled. A bared DM was achieved in all cases. A donor cornea without (group 1; 48 eyes) or with (group 2; 22 eyes) DM was sutured to the recipient bed. The two groups were compared in terms of best spectacle-corrected visual acuity (BSCVA), keratometric astigmatism, refractive error, contrast sensitivity, higher-order aberrations, and central graft thickness at least 3 months after complete suture removal. Additionally, the rate of postoperative pseudo-anterior chamber formation was compared between the study groups.

Mean follow-up duration was 23.2±6.9 months in group 1 and 26.5±6.5 months in group 2 (P=0.61). Postoperative BSCVA was 0.18±0.08 logMAR and 0.24±0.30 logMAR, respectively (P=0.36). The two groups were comparable regarding postoperative keratometric astigmatism, spherical equivalent refraction and higher-order aberrations. In terms of contrast sensitivity, however, group 1 demonstrated better results at low spatial frequency. Mean postoperative central graft thickness was thicker in group 2 (589.8±34.5 ?m) than in group 1 (523.6±63.0 ?m; P<0.001)

DALK using the big-bubble technique for keratoconus may entail better results in terms of contrast sensitivity if a donor cornea without DM is transplanted.