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

Abstract

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.

Comparison of Visual Outcomes of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty

“…DM perforation rate has been reported between 4.0%-39.2% and large DM tears needing conversion to PK between 2.3%-27.3% in the literature. 13,14 Our rates are consistent with these reports.…”

“…This finding is consistent with previous report of 46.2% vs. 1.3%. 13 It is likely to be a consequence of the use of steroid drops for shorter period and lower intensity after DALK.…”

Corneal Transplantation and Glaucoma

“…148 Postoperative corticosteroid courses differed in the two groups, at least six months in eyes after DALK and at least 12 months in eyes after PK. There were no rejections in the DALK group, whereas 7.7% of the PK group suffered endothelial rejection.…”

Studies On Survival Of Corneal Tissue Transplantation In Patients With Keratoconus

“…However, when analyzed in their studies individually, they showed significance with direct interference in the success of transplanted tissue [19][20][21][22][23][24].…”