EJO ISSN 1120-6721 Eur J Ophthalmol 2015; 25 (2): 90-95 © 2014 Wichtg Publishing ORIGINAL ARTICLE report on the efect of the posterior donor surface on the qual- ity of the donor-recipient interface. Recently, we demonstrated that DALK using the big- bubble technique for keratoconus may give beter clinical results if a donor cornea without DM is transplanted (11). Donor cellular profles as well as the healing response be- tween donor and recipient corneas can also be afected by the graf preparaton method. It has been demonstrated that when a full-thickness graf with retained DM is used, healing is delayed at the donor-recipient interface and a subclinical clef (pseudo-anterior chamber) usually develops (12). To our knowledge, no study has yet reported the impact of retaining versus removing donor DM and endothelium on healing of the donor-recipient interface afer DALK. In the present study, we employed in vivo confocal microscopy to evaluate the efect of donor DM and endothelium retenton versus removal on graf cellular profles as well as features of the donor-recipient interface in a group of patents with kera- toconus who underwent Anwar big-bubble technique. Materials and Methods In this retrospectve comparatve study, data were com- piled from consecutve patents undergoing Anwar big bubble DALK for moderate (mean keratometry 48-55 D) and advanced DOI: 10.5301/ejo.5000470 Donor Descemet-of versus Descemet-on deep anterior lamellar keratoplasty: a confocal scan study Sepehr Feizi, Mohammad Zare, Seyed Bagher Hosseini, Mozhgan Rezaee Kanavi, Shahin Yazdani Ophthalmic Research Center, Shahid Behesht University of Medical Sciences, Tehran - Iran Introducton Diferent techniques of lamellar keratoplasty have evolved over tme to achieve visual outcomes comparable to penetrat- ing keratoplasty (PK). Among these techniques, deep anteri- or lamellar keratoplasty (DALK) in which a maximal depth of corneal stroma is removed has gained popularity for manage- ment of corneal stromal pathologies not involving the endo- thelium (1-9). Untl now, the quality of the recipient bed has been considered as the only factor afectng donor-recipient interface regularity following DALK. It has been demonstrated that when the recipient corneal stroma is removed down to Descemet membrane (DM), the optcal quality of the interface is excellent and comparable to PK (10). However, there is no ABSTRACT Purpose: To compare confocal features of grafs following deep anterior lamellar keratoplasty (DALK) using a donor without Descemet membrane (DM) versus a full-thickness donor with intact DM and endothelium. Methods: This retrospectve comparatve study examined 45 eyes from patents with keratoconus who under- went DALK using the big-bubble technique. The big-bubble technique yielded a bared DM in all keratoconic eyes. Twenty-seven eyes received tssue from a donor without DM (group 1), while 18 received tssue from a full- thickness donor with an intact DM and endothelium (group 2). A group of normal eyes (n = 28, group 3) served as controls. Confocal microscopy was used to determine keratocyte density, explore the donor-recipient interface including clarity and refectvity, evaluate endothelial cell density and morphology, as well as measure interface depth and central corneal thickness. Results: Mean follow-up duraton was 20.2 ± 8.6 months and 29.6 ± 17.0 months in groups 1 and 2, respectvely (p = 0.13). Confocal scan demonstrated that the keratocyte profles and distributon were more similar to normal corneas in group 2. Signifcantly more severe interface haziness was observed when donor DM and endothelium was retained (mean interface refectvity value of 102.7 ± 22.1 versus 161.7 ± 30.0 light refectance units in groups 1 and 2, respectvely, p<0.001). Conclusions: Graf cellular profles and healing response at the donor-recipient interface can be profoundly afected depending on whether donor DM and endothelium is removed or retained. Keywords: Big-bubble technique, Confocal scan, Deep anterior lamellar keratoplasty, Donor Descemet membrane, Keratoconus Accepted: March 16, 2014 Published online: April 9, 2014 Corresponding author: Sepehr Feizi Ophthalmic Research Center Labbafnejad Medical Center Boostan 9 St Pasdaran Ave Tehran 16666, Iran sepehrfeizi@yahoo.com