{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:54:05Z","timestamp":1782352445022,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,3,11]],"date-time":"2015-03-11T00:00:00Z","timestamp":1426032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the clinical findings and results of manual dissection deep anterior lamellar keratoplasty (<jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content>) compared to a modified big\u2010bubble <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> technique in eyes affected by keratoconus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixty eyes of 60 patients with keratoconus were treated with one of the two surgical techniques manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> (<jats:italic>n<\/jats:italic>\u00a0=\u00a030); big\u2010bubble <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> (<jats:italic>n<\/jats:italic>\u00a0=\u00a030). The main outcomes measured were visual acuity, corneal topographic parameters, thickness of residual stroma and endothelial cell density (<jats:styled-content style=\"fixed-case\">ECD<\/jats:styled-content>). Patients were examined postoperatively at 1\u00a0month, 6\u00a0months, 1\u00a0year and 1\u00a0month after suture removal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Final best spectacle\u2010corrected visual acuity (<jats:styled-content style=\"fixed-case\">BSCVA<\/jats:styled-content>) measured 1\u00a0month after suture removal was 0.11\u00a0\u00b1\u00a00.08 Log<jats:styled-content style=\"fixed-case\">MAR<\/jats:styled-content> in the big\u2010bubble group compared to 0.13\u00a0\u00b1\u00a00.08 in the manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> group (p\u00a0=\u00a00.227). In patients treated with the big\u2010bubble technique without complications (Descemet's membrane completely bared), the stromal residue was not measureable. Mean stromal residual thickness in the manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> group was 30.50\u00a0\u00b1\u00a027.60\u00a0<jats:italic>\u03bc<\/jats:italic>m. Data analysis of the manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> group demonstrated a significant correlation between <jats:styled-content style=\"fixed-case\">BSCVA<\/jats:styled-content> and residual stromal thickness; lower residual stromal thickness correlated with better <jats:styled-content style=\"fixed-case\">BSCVA<\/jats:styled-content> values (Spearman <jats:italic>\u03c1<\/jats:italic>\u00a0=\u00a00.509, p\u00a0=\u00a00.018). Postoperative <jats:styled-content style=\"fixed-case\">ECD<\/jats:styled-content> was similar in both groups at all intervals, with no statistically significant differences. In both groups, <jats:styled-content style=\"fixed-case\">ECD<\/jats:styled-content> loss was only significant during the 1\u2010 to 6\u2010month interval (p\u00a0=\u00a00.001 and p\u00a0&lt;\u00a00.001 in the big\u2010bubble <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> and manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> groups, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> provides comparable results to big\u2010bubble <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content>. Big\u2010bubble <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> permits faster visual recovery and is a surgical technique, which can be easily converted to manual <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content> in cases of unsuccessful \u2018big\u2010bubble\u2019 formation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.12705","type":"journal-article","created":{"date-parts":[[2015,3,11]],"date-time":"2015-03-11T10:04:14Z","timestamp":1426068254000},"page":"431-438","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Modified big\u2010bubble technique compared to manual dissection deep anterior lamellar keratoplasty in the treatment of keratoconus"],"prefix":"10.1111","volume":"93","author":[{"given":"Karl Anders","family":"Knutsson","sequence":"first","affiliation":[{"name":"Department of Ophthalmology San Raffaele Scientific Institute Milan 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