Deep anterior lamellar keratoplasty with Intacs explantation in keratoconus

PURPOSE. To describe the surgical technique and clinical outcome of deep anterior lamellar keratoplasty (DALK) with Intacs explantation in patients with poor visual outcome after Intacs implantation for keratoconus correction. METHODS. Two patients with bilateral keratoconus underwent Intacs segment implantation. Due to poor visual outcome and patient dissatisfaction, the Intacs segments were explanted and a big bubble-assisted DALK procedure was performed at the time of Intacs removal. RESULTS. DALK could be successfully completed in both cases. There were no postoperative complications. At 2 years follow-up, the grafts were clear in both patients, with a best spectacle-corrected visual acuity of 20/25. CONCLUSIONS. A modified big bubble-assisted DALK procedure can be performed in keratoconic eyes requiring Intacs explantation and may provide a better alternative to a penetrating keratoplasty. (Eur J Ophthalmol 2010; 20: 874-8)