Report The Clinical Effect Of Curing 2 Patients (3 Eyes) With Macula Corneal Dystrophy Through The "Big Bubble Technque" Combined With "Small Bubble Technique" Of Deep Anterior Lamellar Keratoplasty (DALK)

Objective: Report the clinical effect of curing 2 patients (3 eyes) with macula corneal dystrophy through the"big bubble technique"combined with"small bubble technique"of deep anterior lamellar keratoplasty (DALK).Methods: 2 patients (3 eyes) diagnosed with macula corneal dystrophy in January 2009 in our hospital was chosen."big bubble technique"of injecting sterile air to deep corneal stroma assisted by Iris Restorer was used to separate the corneal stroma and descemet's membrane."Small bubble technique"of injecting a small amount of sterile air to anterior chamber is used to judge the separation effect and guide to wipe off all the corneal stromal framework. Corneal donors were cryopreservation corneo- sclera pieces which were from eye-bank in our hospital. ( pure glycerol - 20℃conservation). So far as postoperative follow-up (3～4 months), preoperative,postoperative visual acuity,postoperative corneal grafts,plant bed,endothelial,intraoperative and postoperative complications were recorded.Results: Two patients (3 eyes) all had a successful surgery."Big bubble technique"combined with"small bubble technique"of deep anterior lamellar keratoplasty is applied to separate corneal stroma and DM in the field of plant bed, then all stroma was removed and Smooth and transparent DM were exposed, meanwhile there was no complication of DM perforation happened. Postoperative visual acuity of the two patient's (3 eyes) was improved in 2 weeks and obviously superior to preoperative. Postoperative visual acuity of patient whose two eyes were operated are 0.3(corrected visual acuity had no improvement) in case 1. The right eye's visual acuity achieved naked visual acuity 1.0 and the left eye's visual acuity achieved naked visual acuity 0.8 (corrected visual acuity is 1.0) after postoperation one month. For case 2, preoperative visual acuity was 0.05(corrected visual acuity has no improvement) and the eye's vision achieved naked visual acuity 0.5 after postoperation one month (corrected visual acuity is 0.8), and 0.6 after postoperation two month (corrected visual acuity is 1.0). Patients in the two cases had stable visual acuity in the latter follow-up. Corneal grafts and bed (auto DM) of the two patients were closely attached. There are no interlaminar effusion and obvious DM's fold. Plants get transparent after postoperation 2 weeks. Corneal endothelium examinations had shown normal endothelium's shape and quantity. There were no other complications in follow-up period.Conclusion: Macula corneal dystrophy is seldom cases. Lesions can be extended to the deep corneal stroma and has serious influence on patients'visual acuity. In this report,"big bubble technique"combined with"small bubble technique"of deep anterior lamellar keratoplasty is successfully used to cure 2 patients(3 eyes) with macula corneal dystrophy. Good effect is achieved in a short postoperative period. The improved surgical technique is safe and no apparent intra and postoperative complications. Long-term effects need to be further observed.