Corneal endothelium after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus: A four-year comparative study

Kubaloğlu, Anıl; Koytak, Arif; Sarı, Esin Söğütlü; Akyol, Sibel; Kurnaz, Ekrem; Özertürk, Yusuf

doi:10.4103/0301-4738.90490

Cited by 42 publications

(25 citation statements)

References 22 publications

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“…Sarnicola et al [ 54 ] reported no progressive endothelial cell loss in postoperative DALK patients during a 6-month follow-up period. Five-year long-term data showed that the mean 5-year endothelial cell loss was 22.3% in the DALK group and 50.1% in PKP group, which is similar to the finding of Kubaloglu A et al [ 35 ]. Although the mean ECC in PKP group was reduced more than that in DALK group, but we found there was no statistically significant difference between the mean CCT of the two groups.…”

Section: Discussionsupporting

confidence: 88%

Efficacy and Safety of Deep Anterior Lamellar Keratoplasty vs. Penetrating Keratoplasty for Keratoconus: A Meta-Analysis

et al. 2015

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PurposeTo evaluate difference in therapeutic outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for the clinical treatment of keratoconus.MethodsA comprehensive search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of science. Eligible studies should include at least one of the following factors: best corrected visual acuity (BCVA), postoperative spherical equivalent (SE), postoperative astigmatism and endothelial cell count (ECC), central corneal thickness (CCT), graft rejection and graft failure, of which BCVA, graft rejection and graft failure were used as the primary outcome measures, and postoperative SE, astigmatism, CCT and ECC as the secondary outcome measures. Given the lack of randomized clinical trials (RCTs), cohort studies and prospective studies were considered eligible.ResultsSixteen clinical trials involving 6625 eyes were included in this review, including 1185 eyes in DALK group, and 5440 eyes in PKP group. The outcomes were analyzed using Cochrane Review Manager (RevMan) version 5.0 software. The postoperative BCVA in DALK group was significantly better than that in PKP group (OR = 0.48; 95%CI 0.39 to 0.60; p<0.001). There were fewer cases of graft rejection in DALK group than those in PKP group (OR = 0.28; 95%CI 0.15 to 0.50; p<0.001). Nevertheless the rate of graft failure was similar between DALK and PKP groups (OR = 1.05; 95%CI 0.81 to 1.36; p = 0.73). There were no significant differences in the secondary outcomes of SE (p = 0.70), astigmatism (p = 0.14) and CCT (p = 0.58) between DALK and PKP groups. And ECC in DALK group was significantly higher than PKP group (p<0.001). The postoperative complications, high intraocular pressure (high-IOP) and cataract were analyzed, fewer cases of complications occurred in DALK group than those in PKP group (high-IOP, OR 0.22, 95% CI 0.11–0.44, P<0.001) (cataract, OR 0.22; 95% CI 0.08–0.61, P = 0.004). And no cases of expulsive hemorrhage and endophthalmitis were reported.ConclusionThe visual outcomes for DALK were not equivalent to PKP. The rate of graft failure was similar between DALK and PKP. Fewer postoperative complications occurred in DALK group, indicating that compared with PKP, DALK has lower efficacy but higher safety.

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Section: Discussionsupporting

confidence: 88%

Efficacy and Safety of Deep Anterior Lamellar Keratoplasty vs. Penetrating Keratoplasty for Keratoconus: A Meta-Analysis

et al. 2015

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“…1 Endothelial cell analysis is one of the methods that is used to assess the health of the cornea, especially after surgical intervention 2 and is also one of the major criteria that are used to assess the long-term outcomes of any corneal surgery. 3 …”

Section: Introductionmentioning

confidence: 99%

Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

Badawi¹

2016

OPTH

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PurposeThe purpose of this study was to evaluate the effects of accelerated cross-linking (CXL) on corneal endothelium in keratoconus and postlaser-assisted in situ keratomileusis (LASIK) ectasia.DesignThis study is a prospective nonrandomized controlled study.SettingThis study was conducted in Mansoura Ophthalmic Center (Mansoura University) and Al-Mostakbal Ophthalmic Center, Mansoura, Egypt.MethodsIn total, 40 eyes with progressive keratoconus and 10 eyes with postLASIK ectasia were subjected to an accelerated CXL (10 mW/cm2 for 9 minutes). Qualitative and quantitative analyses of the corneal endothelial cells were conducted before CXL and 3, 6, and 12 months after CXL by using a specular microscope (Tomy EM-3000).ResultsThere was a significant reduction in endothelial cell count particularly at 3 and 6 months postCXL. In addition, the coefficient of variance was also statistically significantly higher at 3 and 6 months postoperatively than the preCXL value. There was a slight change in the percentage of hexagonal cells.ConclusionThe use of accelerated CXL (10 mW/cm2 for 9 minutes) has a transient negative impact on endothelial cell density and/or endothelial morphology.

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“…Furthermore the preservation of the host endothelium reduces the risk of corneal endothelial failure due to endothelial cell loss or rejection [4]. …”

Section: Introductionmentioning

confidence: 99%

Descemetic and Predescemetic DALK in Keratoconus Patients: A Clinical and Confocal Perspective Study

Schiano-Lomoriello

Colabelli-Gisoldi

Nubile

et al. 2014

BioMed Research International

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Purpose. To evaluate the clinical outcomes and in vivo confocal microscopy (IVCM) features of keratoconus patients who underwent deep anterior lamellar keratoplasty (DALK). Methods. DALK was performed using the big bubble technique in all the patients. If the bubble was not successful to bare the descemet membrane, a manual dissection layer-by layer was performed to expose a deep stromal plane close to the DM. The patients were divided in two groups depending on the intraoperative baring of the descemet membrane: predescemetic DALK (PD-DALK) and descemetic DALK (D-DALK) group. Results. One month after surgery the D-DALK patients show an increase of mean BCVA. In the PD-DALK group mean BCVA did not show significant improvement as compared to preoperative values. At 6 months after surgery mean BCVA was found to be similar in both groups. At 1 month IVCM the peak of reflectivity of the interface was lower in D-DALK group compared to PD-DALK. At 6 months the values of reflectivity were comparable. Conclusions. At 1 month D-DALK seems to lead to a minor interface reflectivity and to a better BCVA; these differences disappear after 6 months and the values of interface reflectivity and BCVA are comparable between D-DALK and PD-DALK.

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Corneal endothelium after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus: A four-year comparative study

Cited by 42 publications

References 22 publications

Efficacy and Safety of Deep Anterior Lamellar Keratoplasty vs. Penetrating Keratoplasty for Keratoconus: A Meta-Analysis

Efficacy and Safety of Deep Anterior Lamellar Keratoplasty vs. Penetrating Keratoplasty for Keratoconus: A Meta-Analysis

Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

Descemetic and Predescemetic DALK in Keratoconus Patients: A Clinical and Confocal Perspective Study

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