Descemetic DALK and Predescemetic DALK: Outcomes in 236 Cases of Keratoconus

Sarnicola, Vincenzo; Toro, Patricia; Gentile, Domenico; Hannush, Sadeer B.

doi:10.1097/ico.0b013e3181a31aea

Cited by 151 publications

(135 citation statements)

References 18 publications

(25 reference statements)

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“…The many techniques that have been developed for performing DALK share the disadvantages of being time-consuming and technically difficult. DM perforation has a rate of incidence of between 4.0% and 39.2% (Sugita and Kondo, 1997;Coombes et al, 2001;Fontana et al, 2007;Marchini et al, 2006;Sarnicola et al, 2010), and large DM tears needing conversion to PK have a rate of incidence of from 2.3% to 3.5% (Feizi et al, 2010;Kubaloglu et al, 2011;Sarnicola and Toro, 2011). Using the stromalhooking and viscoelastic-detaching technique in handling keratoconus for 76 eyes, microperforation of the DM occurred in 9.3% (7 out of 75) of eyes.…”

Section: Discussionmentioning

confidence: 99%

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Zhang

Yao

2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.

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Section: Discussionmentioning

confidence: 99%

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Zhang

Yao

2013

J. Zhejiang Univ. Sci. B

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“…The relatively limited data currently available on the visual outcomes of DALK, with or without the baring of Descemet's membrane (DM), compared with those of PKP [17][18][19][20][21][22][23][24][25][26] and whether or not the better safety profile afforded by DALK offsets any such visual disparity that may exist, make it difficult to determine which procedure offers the best overall prognosis for the management of KC. In the present paper, we performed a retrospective, sequential, and comparative study of the outcomes of PKP, DALK without baring of DM, and DALK with baring of DM that were progressively introduced by the same experienced corneal surgeons at a single center during the past decade so as to evaluate the visual outcomes and safety profiles of these surgical techniques in the management of KC.…”

Section: Introductionmentioning

confidence: 98%

Penetrating keratoplasty versus deep anterior lamellar keratoplasty for the treatment of keratoconus

et al. 2010

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“…An assessment of the endothelial cell density (ECD) is a commonplace method of pre-and post-operative monitoring of a corneal graft by using either specular microscopy [2][3][4][5][6][7][8] or, more recently, confocal microscopy. [9][10][11][12] Such high-resolution imaging of the corneal endothelium is generally needed to allow for endothelial cell counting and this is done, as it has long been recognised that a very low endothelial cell count may ultimately lead to reduced endothelial function and to subsequent graft failure. For such assessments, it is important that the method of assessment of ECD is reasonably reliable.…”

Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

Jonuscheit

Doughty

Ramaesh

2011

Eye

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Purpose The purpose of this study was to assess the endothelium of corneal grafts by in vivo confocal microscopy (IVCM), and to evaluate an automated endothelial software system in comparison with a manual cell count and planimetry. Patients and methods Overall, 40 corneal grafts (20 deep anterior lamellar keratoplasties (DALKs) and 20 penetrating keratoplasties (PKs)) were assessed by scanning-slit IVCM. The endothelial cell density (ECD) was estimated with the automated and the manual cell count method of the instrument's Nidek Advanced Vision Information System (NAVIS) software. The results were compared with planimetry as the reference method, and the agreement was assessed. Results The mean ( ± SD) automated ECD was 2278 ± 524 cells/mm 2 (range 1167-3192 cells/mm 2 ), whereas the manual cell count method gave significantly lower ECDs with a mean of 1213±677 cells/mm 2 (range 218-2440 cells/mm 2 ; Po0.001). The manual cell counts were also significantly lower than those by planimetry, with a mean ECD of 1617 ± 813 cells/mm 2 (range 336-2941, Po0.001). Bland-Altman analyses indicated that the limits of agreement (LoA) between the automated and the planimetry method were À671 and þ 1992 cells/mm 2 , whereas they were À1000 and þ 202 cells/mm 2 when comparing the manual cell counts with planimetry. Conclusion Following keratoplasty, the NAVIS automated method is likely to overestimate endothelial cell counts due to oversegmenting of the cell domains. Automated ECDs are substantially higher than those by the manual counting method or planimetry. The differences are considerably larger post-keratoplasty than for normal corneas, and the methods should not be used interchangeably.

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Descemetic DALK and Predescemetic DALK: Outcomes in 236 Cases of Keratoconus

Abstract: Performing DALK, we had the greatest likelihood of reaching Descemet's membrane with the Anwar Big Bubble technique. The visual outcomes are comparable to standard PK, avoiding the risk of endothelial rejection. Endothelial cell loss was low and the cell count was stable after 6 months.

Cited by 151 publications

References 18 publications

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Penetrating keratoplasty versus deep anterior lamellar keratoplasty for the treatment of keratoconus

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

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