{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:54:06Z","timestamp":1782352446432,"version":"3.54.5"},"reference-count":35,"publisher":"Elsevier BV","issue":"7","license":[{"start":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T00:00:00Z","timestamp":1498867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","aaojournal.org","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmology"],"published-print":{"date-parts":[[2017,7]]},"DOI":"10.1016\/j.ophtha.2017.02.011","type":"journal-article","created":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T13:30:20Z","timestamp":1490016620000},"page":"1072-1080","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":56,"title":["Large (9 mm) Deep Anterior Lamellar Keratoplasty with Clearance of a 6-mm Optical Zone Optimizes Outcomes of Keratoconus Surgery"],"prefix":"10.1016","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3635-3521","authenticated-orcid":false,"given":"Massimo","family":"Busin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Leon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0246-4787","authenticated-orcid":false,"given":"Yoav","family":"Nahum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6826-7957","authenticated-orcid":false,"given":"Vincenzo","family":"Scorcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ophtha.2017.02.011_bib1","doi-asserted-by":"crossref","first-page":"2432","DOI":"10.1016\/j.ophtha.2015.08.017","article-title":"Keratoplasty in the United States: a 10-year review from 2005 through 2014","volume":"122","author":"Park","year":"2015","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib2","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1097\/TP.0b013e31822d882d","article-title":"Corneal transplantation: changing techniques","volume":"92","author":"Mohamed-Noriega","year":"2011","journal-title":"Transplantation"},{"key":"10.1016\/j.ophtha.2017.02.011_bib3","series-title":"Eye Bank Association of America (EBAA) 2015 Eye Banking Statistical Report","year":"2015"},{"key":"10.1016\/j.ophtha.2017.02.011_bib4","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.ophtha.2013.12.017","article-title":"A\u00a0comparison of lamellar and penetrating keratoplasty outcomes: a registry study","volume":"121","author":"Coster","year":"2014","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib5","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/ICO.0000000000000691","article-title":"Deep anterior lamellar keratoplasty versus penetrating keratoplasty: a meta-analysis of randomized controlled trials","volume":"35","author":"Chen","year":"2016","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib6","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ophtha.2010.11.002","article-title":"Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the American Academy of Ophthalmology","volume":"118","author":"Reinhart","year":"2011","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib7","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.ophtha.2011.07.057","article-title":"Long-term results of deep anterior lamellar versus penetrating keratoplasty","volume":"119","author":"Borderie","year":"2012","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib8","first-page":"CD009700","article-title":"Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus","author":"Keane","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ophtha.2017.02.011_bib9","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.ajo.2009.07.011","article-title":"Deep anterior lamellar keratoplasty: when should it replace penetrating keratoplasty?","volume":"148","author":"Sutphin","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib10","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.ajo.2009.05.028","article-title":"Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus","volume":"148","author":"Han","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ajo.2015.12.033","article-title":"Outcomes of air injection within 2 mm inside a deep trephination for deep anterior lamellar keratoplasty in eyes with keratoconus","volume":"164","author":"Busin","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib12","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1016\/j.ophtha.2013.01.018","article-title":"Human corneal anatomy redefined: a novel pre-Descemet's layer (Dua's layer)","volume":"120","author":"Dua","year":"2013","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib13","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.ajo.2010.11.020","article-title":"Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus","volume":"151","author":"Kubaloglu","year":"2011","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib14","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ajo.2005.08.064","article-title":"Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus","volume":"141","author":"Fogla","year":"2006","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib15","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0161-6420(03)00659-6","article-title":"Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after suture removal","volume":"110","author":"Seitz","year":"2003","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib16","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1136\/bjophthalmol-2014-306170","article-title":"Large-diameter deep anterior lamellar keratoplasty for keratoconus: visual and refractive outcomes","volume":"99","author":"Huang","year":"2015","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib17","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1097\/ICO.0b013e3181b6489e","article-title":"Large-diameter penetrating keratoplasty: indications and outcomes","volume":"29","author":"Skeens","year":"2010","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ajo.2006.09.025","article-title":"Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus","volume":"143","author":"Fontana","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib19","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0886-3350(01)01181-6","article-title":"Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty","volume":"28","author":"Anwar","year":"2002","journal-title":"J\u00a0Cataract Refract Surg"},{"key":"10.1016\/j.ophtha.2017.02.011_bib20","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1136\/bjo.2009.167528","article-title":"Visual acuity outcomes after deep anterior lamellar keratoplasty: a case-control study","volume":"94","author":"Tan","year":"2010","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib21","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/ICO.0b013e3181af25b7","article-title":"Deep anterior lamellar keratoplasty in patients with keratoconus: big-bubble technique","volume":"29","author":"Feizi","year":"2010","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib22","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/ICO.0b013e3181a31aea","article-title":"Descemetic DALK and predescemetic DALK: outcomes in 236 cases of keratoconus","volume":"29","author":"Sarnicola","year":"2010","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib23","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/aos.12705","article-title":"Modified big-bubble technique compared to manual dissection deep anterior lamellar keratoplasty in the treatment of keratoconus","volume":"93","author":"Knutsson","year":"2015","journal-title":"Acta Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib24","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1097\/ICO.0b013e31823f8c85","article-title":"Pentacam-based big bubble deep anterior lamellar keratoplasty in patients with keratoconus","volume":"31","author":"Riss","year":"2012","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib25","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jtos.2014.05.004","article-title":"Recurrence or re-emergence of keratoconus - what is the evidence telling us? Literature review and two case reports","volume":"12","author":"Bermansson","year":"2014","journal-title":"Ocul Surf"},{"key":"10.1016\/j.ophtha.2017.02.011_bib26","first-page":"T11","article-title":"A\u00a0two-piece microkeratome-assisted mushroom keratoplasty improves the outcomes and survival of grafts performed in eyes with diseased stroma and healthy endothelium (an American Ophthalmological Society Thesis)","volume":"113","author":"Busin","year":"2015","journal-title":"Trans Am Ophthalmol Soc"},{"key":"10.1016\/j.ophtha.2017.02.011_bib27","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1097\/QAI.0b013e31815d2f71","article-title":"Manual trephination of mushroom keratoplasty in advanced keratoconus","volume":"27","author":"Saelens","year":"2008","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib28","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/ICU.0b013e32833a8dbc","article-title":"Femtosecond laser-assisted corneal surgery","volume":"21","author":"Farid","year":"2010","journal-title":"Curr Opin Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib29","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/ICU.0b013e3281a4776c","article-title":"Femtosecond laser-assisted corneal surgery","volume":"18","author":"Mian","year":"2007","journal-title":"Curr Opin Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib30","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/ICO.0b013e31815b7d50","article-title":"Femtosecond laser-assisted penetrating keratoplasty: stability evaluation of different wound configurations","volume":"27","author":"Bahar","year":"2008","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib31","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0161-6420(01)00966-6","article-title":"Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology","volume":"109","author":"Sugar","year":"2002","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2017.02.011_bib32","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/bjophthalmol-2013-303737","article-title":"Comparison between femtosecond laser mushroom configuration and manual trephine straight-edge configuration deep anterior lamellar keratoplasty","volume":"98","author":"Shehadeh-Mashor","year":"2014","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ophtha.2017.02.011_bib33","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/ICO.0b013e318033b4e9","article-title":"Deep anterior lamellar keratoplasty for post-LASIK ectasia","volume":"26","author":"McAllum","year":"2007","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib34","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1097\/ICO.0b013e318242fdae","article-title":"Outcomes of deep anterior lamellar keratoplasty for keratoconus: learning curve and advantages of the big bubble technique","volume":"31","author":"Smadja","year":"2012","journal-title":"Cornea"},{"key":"10.1016\/j.ophtha.2017.02.011_bib35","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/ICO.0000000000000413","article-title":"Pachymetry-guided intrastromal air injection (\u201cpachy-bubble\u201d) for deep anterior lamellar keratoplasty: results of the first 110 cases","volume":"34","author":"Ghanem","year":"2015","journal-title":"Cornea"}],"container-title":["Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0161642016325210?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0161642016325210?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T18:08:02Z","timestamp":1658858882000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0161642016325210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":35,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["S0161642016325210"],"URL":"https:\/\/doi.org\/10.1016\/j.ophtha.2017.02.011","relation":{},"ISSN":["0161-6420"],"issn-type":[{"value":"0161-6420","type":"print"}],"subject":[],"published":{"date-parts":[[2017,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Large (9 mm) Deep Anterior Lamellar Keratoplasty with Clearance of a 6-mm Optical Zone Optimizes Outcomes of Keratoconus Surgery","name":"articletitle","label":"Article Title"},{"value":"Ophthalmology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ophtha.2017.02.011","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2017 by the American Academy of Ophthalmology","name":"copyright","label":"Copyright"}]}}