Deep Lamellar Keratoplasty Versus Penetrating Keratoplasty for Corneal Lesions

Abstract

DLK is a promising procedure and should be practiced more frequently for corneal pathology not involving the endothelium.

Therapeutic deep lamellar keratoplasty for corneal perforations

“…13 More importantly, as a result of preservation of recipient endothelium in DLK, graft rejection rates are low and unlike PK it has a minimal effect on endothelial cell loss. [11][12][13][14]26 In the few reports of stromal graft rejection in DLK, as in patient 1 in this study, reversal of stromal oedema and full recovery of visual function has occurred with intensive topical corticosteroids. 27 This is of particular relevance when considering corneal grafting in inflamed eyes when the risk of rejection is higher.…”

“…10,11 It offers a significant advantage over PK in terms of endothelial graft rejection and prevention of long-term endothelial loss. [10][11][12][13][14] The successful use of DLK in corneal perforation has only been reported in two cases in the literature. 15 We present four cases of noninfectious corneal perforation managed by DLK.…”

Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus

“…4,8,9 There were three cases of rejection in the PK group whereas in the DLK group there was only one case of mild stromal rejection. Watson et al 11 found reported 11 rejection episodes in the 22 PK patients (mainly endothelial rejection) compared to one stromal and one epithelial rejection in the DLKs.…”

“…These include layer-by-layer surgical dissection assisted by the expansion of stromal lamellae with air or balanced salt solution, blunt surgical dissection, or direct separation of Descemet's membrane from the overlying stroma with the injection of air or viscoelastic. [4][5][6][7][8][9] Initial techniques had high endothelial perforation rates (9-25% reported); however, the use of anterior chamber air to allow visualisation of the endothelium has reduced this. [5][6][7] Keratoconus is the commonest condition requiring corneal graft surgery.…”

Outcomes of femtosecond laser-assisted mushroom-configuration keratoplasty in advanced keratoconus

“…[1][2][3] Visual recovery of PKP is often slow because of prolonged wound-healing and irregular astigmatism, and patients are at risk of graft endothelial rejection or failure. 3,4 Despite its advantages, DALK has been slow to gain its popularity until the introduction of big-bubble Descemet membrane (DM) dissection. 5 Stepped corneal trephination was first conceived in 1950s; 6 however, it only became technically possible when it was reintroduced by Busin.…”