To investigate recipient and operative factors that can influence the rate of a bare Descemet membrane (DM) achievement during deep anterior lamellar keratoplasty (DALK) in keratoconus

In this retrospective comparative study, a total of 290 (153 right) consecutive eyes from 257 (179 male) keratoconus-affected patients that underwent DALK with the big-bubble technique were enrolled. Univariate analyses and multiple logistic regressions were used to investigate factors including patient age and sex, family history of keratoconus, history of contact lens wear or vernal keratoconjunctivitis, the presence of Vogt’s striae or superficial opacities, keratometric readings, central and peripheral corneal thickness, anterior chamber depth, vitreous length, and trephination size which could predict achievement of a bare DM.

The surgery was completed as DALK in 289 of 290 eyes and a bare DM was successfully achieved in 229 (79.2%) eyes. The recipient sex and trephination size significantly influenced the success rate of big-bubble formation. The female sex decreased the odds of bare DM achievement by 0.44 times (P=0.02). For each 0.1-mm increase in the trephination size, the odds of the successful big-bubble formation increased by 1.36 times (P=0.03). Other investigated factors did not significantly influence the rate of successful bare DM achievement

The surgery was completed as DALK in 289 of 290 eyes and a bare DM was successfully achieved in 229 (79.2%) eyes. The recipient sex and trephination size significantly influenced the success rate of big-bubble formation. The female sex decreased the odds of bare DM achievement by 0.44 times (P=0.02). For each 0.1-mm increase in the trephination size, the odds of the successful big-bubble formation increased by 1.36 times (P=0.03). Other investigated factors did not significantly influence the rate of successful bare DM achievement