Deep Lamellar Keratoplasty in the Treatment of Keratoconus

Abstract

Purpose: To present our experience with a series of patients treated with deep lamellar keratoplasty (DLK) for keratoconus (KC). Design: A single surgeon, prospective, consecutive series.Method: The study included all patients with KC who underwent DLK between March 1999 and November 2003 at the Royal Adelaide Hospital. The parameters evaluated included patients’ demographics, pre- and post-operative best corrected visual acuities, post-operative keratometry, and intra- and post-operative complications. Results: There were 22 patients (23 eyes); 10 females and 12 males, with a mean age of 35 ± 13 years (median, 33.5; range, 17–73). The median follow-up period was 13 months (range 7–38). In 89% (16/18) of eyes which underwent DLK, and in which a visual acuity could be obtained, a best corrected visual acuity of at least 6/12 was recorded. There were two episodes of Descemet’s membrane perforation (8.7%), in which the procedure was converted to penetrating keratoplasty without complications. One patient developed a double anterior chamber, which resolved spontaneously without consequences. Conclusion: The visual outcomes and complication rates seen in our series are comparable to the recent published literature. Hence DLK can be considered as a suitable alternative to penetrating keratoplasty for the surgical treatment of KC.

Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty

“…10 After DALK, resultant anisometropia might decrease the overall success of the procedure. Previous studies report a mean postoperative SE of À1.50 to À6.54 D, although the refractive errors in individual eyes ranged from C2.88 to À9.50 D. [2][3][4][5][6][7][8][9][10][11][12]14 The amount of myopic SE was greater when the thickness of the residual recipient stromal bed increased, although the amount of astigmatism was not affected. 6 The mean postoperative cylindrical refractive error ranged from 2.06 to 4.55 D (0.00 to 10.00 D in individual patients).…”

“…1 Similar to penetrating keratoplasty (PKP), postoperative refractive error is a frequent finding after DALK. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] To date, few reports have addressed photorefractive keratectomy (PRK) with or without use of mitomycin-C (MMC) in eyes with previous DALK. 12,13 Although the outcomes of 1-stage or 2-stage laser in situ keratomileusis (LASIK) after PKP have been reported, [15][16][17][18][19][20][21][22][23] LASIK to correct refractive errors after DALK has not been.…”

“…6 The mean postoperative cylindrical refractive error ranged from 2.06 to 4.55 D (0.00 to 10.00 D in individual patients). [2][3][4][5][6][7][8][9][10][11][12]14 A randomized multicenter clinical trial found a statistically insignificant trend toward fewer patients having greater than 3.00 D topographic astigmatism after DALK than after PKP. 14 Other studies 4,6,8,9,17,18 found that in DALK eyes after complete suture removal, the amount of astigmatism was less than or comparable to that with PKP.…”

Descemet's membrane perforation during deep anterior lamellar keratoplasty: Prognosis

“…13 After perforation, the rate of immediate conversion to PKP in the most recent reports ranges from 0% to 100% 7-13 ; including the present series, conversion has been reported in 8 of 53 eyes (15%). [7][8][9][10][11][12][13] The moment of perforation is crucial for the completion and the success of DALK. Early perforations lead to a greater residual stroma and hence slower visual rehabilitation because of a hazy stromal interface.…”

Intraoperative perforation of Descemet's membrane during “big bubble” deep anterior lamellar keratoplasty

“…It is a useful therapeutic option for treating anterior to mid-stromal corneal opacities. The absence of endothelial corneal graft rejection along with optimal visual outcomes makes DALK a preferred choice for treating corneal stromal pathologies like keratoconus and corneal stromal dystrophies [3][4][5][6][7][8]. However, since the procedure involves baring of Descemet's membrane, which has a thickness of 8-12 lm, intraoperative perforations may occur, especially during the learning curve of the surgery.…”