Evaluation of the risk factors associated with conversion of intended deep anterior lamellar keratoplasty to penetrating keratoplasty.

705 eyes were included, with conversion to PK occurring in 16.2% (n=114) of cases. The factors that remained significant in multivariate analysis were corneal scarring (OR=3.52, p<0.001), manual dissection (OR=42.66, p<0.001), type 2 bubble (OR=90.65, p<0.001) and surgeon inexperience (OR=10.86, p<0.001). A receiver operating characteristic (ROC) curve based on the factors significant in the multivariate binary logistic regression analysis achieved a sensitivity of 89.5% (95% CI 82.3% to 94.4%) and a specificity of 80.2% (95% CI 76.8% to 83.3%) with an area under the ROC curve of 0.91 (95% CI 0.88 to 0.93) (p<0.001) CONCLUSION: Occurrence of a type 2 bubble, the need for manual dissection, the presence of scarring and surgeon inexperience are independent risk factors for the need to convert intended DALK to PK. Correct identification and management of the type of bubble achieved during pneumatic dissection is instrumental in minimising the rate of conversion to PK.