الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Deep anterior lamellar keratoplasty (DALK) has been proposed as an alternative to PK for the treatment of various corneal stromal diseases that do not affect the corneal endothelium. The main advantage of DALK is preservation of endothelium, reducing the risk of immunologic reactions and graft failure. The Big Bubble technique allows the surgeon to gain safe and direct access to DM. This technique represents the most important recent development in DALK. However, BB is not constant even for experienced surgeons and, instead, the corneal stroma is filled with numerous small bubbles. Manual lamellar dissection is then required to complete the procedure, leaving variable thickness of residual stromal. This study was conducted to evaluate DALK using the Big bubble technique. It was a prospective study conducted in Mansoura Ophthalmic Center from January 2018 to September 2019 on 50 eyes of 50 patients suffering from corneal stromal pathologies, not involving DM and endothelium. In this study, 26 eyes (52%) had a successful BB-DALK with complete baring of the DM (group I), while in 24 cases (48%) successful BB was not obtained and were completed by manual layer-by-layer dissection leaving a variable stromal layer overlying the host DM (group II). This study concluded that DALK should be the first choice for the surgical treatment of corneal stromal pathologies sparing DM and endothelium. It is very effective and safe alternative to PK preserving host endothelial cells and eliminating the risk of endothelial rejection. The complete baring of the DM must be considered by the surgeon as the principal goal to achieve intraoperatively using BB technique. However, in cases of Failed Bubble, manual layer-by-layer dissection can be done, rather than converting to PK. Man-DALK showed comparable results to the BB-DALK with final visual outcomes nearly equal in both groups.