Comparison of complications and visual outcomes between big‐bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for fungal keratitis

Abstract

Background To compare the postoperative complications and visual outcomes of big‐bubble deep anterior lamellar keratoplasty (BB‐DALK) and penetrating keratoplasty (PK) for fungal keratitis (FK). Methods This retrospective study included 94 cases of BB‐DALK for FK and 161 cases of PK for FK from a tertiary ophthalmology care centre. Results The most common FK pathogens were Fusarium (n = 84, 32.9%) and Aspergillus (n = 67, 26.3%). The recurrence rates after BB‐DALK and PK were 3.2 and 5%, respectively (p = 0.723). The follow‐up duration was 31.9 ± 15.8 months in the BB‐DALK group and 33.9 ± 15.0 months in the PK group. The immune rejection rate was significantly lower in the BB‐DALK group than in the PK group (1.1 vs. 18.6%, p < 0.001), as was the incidence of secondary glaucoma (p = 0.018). Endothelial cell density in the BB‐DALK group tended to be stable at postoperative month 6, whereas the PK group still attenuated at a hyper‐physiological rate. Postoperative best‐corrected visual acuity (BCVA) significantly improved in both groups (p < 0.001). No significant difference between‐group was observed in BCVA, refractive cylinder, and spherical equivalent postoperatively. Conclusion Big‐bubble DALK is a useful and safe alternative to PK for medically uncontrolled FK.

Management of Filamentous Fungal Keratitis: A Pragmatic Approach

“…Lamellar keratoplasty (LK) as an alternative surgical intervention to treat fungal keratoplasty has been reported in the literature [ 105 , 106 , 107 , 108 , 109 ]. Unlike TPK, which is most frequently performed for perforations (either impending or frank), in the context of FK, lamellar keratoplasty is usually performed to surgically resect infections not extending into the anterior chamber.…”

“…LK has been compared to TPK in two retrospective studies for fungal keratitis [ 105 , 115 ]. An early study from India in the 1960s concluded that “lamellar keratoplasty invariably fails, because the fungus is able to penetrate Descemet’s membrane” after it found that 6/7 LK cases developed re-infection, compared to only 1/10 cases in the TPK group [ 115 ].…”

“…However, a recent retrospective study of 94 LK cases and 161 TPK cases from China using modern surgical techniques found no difference in recurrence rates between groups in terms of recurrence, whilst the immune rejection rate was significantly lower in the LK group (1.1% vs. 18.6%, p < 0.001), along with secondary glaucoma ( p = 0.018). There was no difference in visual acuity or refractive outcome between groups [ 105 ]. Another comparative study conducted for infective keratitis cases (including non-fungal cases) found no significant difference between LK and TPK in terms of therapeutic success ( p = 0.74), whilst LK patients had a significantly greater mean improvement in visual acuity compared to TPK patients (7.27 lines versus 4.76 lines, p = 0.01) [ 116 ].…”

Therapy for contact lens-related ulcers

“…Deep anterior lamellar keratoplasty is slowly becoming a popular option for repairing descemetoceles and perforations. Visual outcomes appear comparable with penetrating keratoplasty with decreased risk for secondary glaucoma and graft rejection [78,79]. However, there is concern for higher reinfection risk due to retained infectious material or infectious seeding of the anterior chamber by Descemet membrane rupture [78,80].…”

Long-Term Outcomes of Big Bubble Deep Anterior Lamellar Keratoplasty in Mucopolysaccharidoses: A Retrospective Case Series and Review of the Literature

“…8 Although deep anterior lamellar keratoplasty (DALK) is an alternative to full-thickness penetrating keratoplasty in patients with anterior corneal disorders and a healthy endothelium and has been shown to offer several advantages, namely, better long-term graft survival, minimal steroid-related complications, no risk of endothelial rejection, and avoidance of open sky surgery, there is a paucity of peer-reviewed literature on long-term follow-up studies of patients with MPS having undergone successful DALK. [9][10][11][12][13][14][15][16][17][18] This study aims to describe the long-term outcomes of patients with MPS type I who have undergone DALK surgery.…”