Visual Outcomes Following Deep Anterior Lamellar Keratoplasty in Granular Corneal Dystrophy Types 1 and 2

Bosch, Lia M uit de; Ormonde, Susan E; Misra, Stuti

doi:10.3341/kjo.2016.30.6.481

Cited by 1 publication

(1 citation statement)

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“…6 Although favorable outcomes after 10 years have been previously reported, 9 there have been studies that have observed recurrence of stromal disease after DALK using 8.00-to 8.5-mm diameter grafts. [22][23][24] Because recurrence may occur even decades after keratoplasty, [22][23][24] studies with longer follow-up are required to confirm the theoretical advantage of using large-diameter grafts.…”

Section: Discussionmentioning

confidence: 99%

Pneumatic Dissection for Large-Diameter (9-mm) Deep Anterior Lamellar Keratoplasty in Eyes With Previous Anterior Lamellar Keratoplasty

Myerscough

Galante

et al. 2020

Cornea

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To evaluate the surgical and 3-year clinical outcomes of modified big-bubble 9-mm deep anterior lamellar keratoplasty (DALK) in eyes with previous ALK (ALK). Methods:In this interventional case series, 21 consecutive eyes with unsatisfactory vision after ALK (superficial ALK n = 9; laserassisted ALK n = 7; and epikeratophakia n = 5) underwent largediameter (9-mm) DALK. The surgery involved deep trephination based on the anterior segment optical coherence tomography pachymetry measurement at 9-mm diameter, pneumatic dissection from the base of the trephination and limited stromal clearance of the optical zone (6 mm). Main outcome measures were success rates of pneumatic dissection, best spectacle-corrected visual acuity, and complication rates.Results: Pneumatic dissection with type 1 bubble formation succeeded in 19 (90%) eyes. In the 2 remaining cases, the 6-mm optical zone was cleared by manual dissection. Perforation occurred in one of the latter cases; no procedure was converted to penetrating keratoplasty. One month after complete suture removal, the preoperative mean best spectacle-corrected visual acuity (0.75 6 0.23 logMAR) improved to 0.09 6 0.10 logMAR (P , 0.001) and remained stable up to 3 years after surgery. At the final follow-up, refractive astigmatism was #4.5 and ,6 D in 20 (95%) and 21 (100%) eyes, respectively. Stromal rejection was observed in 2 eyes (10%) and was treated successfully with steroids.Conclusions: Even in eyes with previous ALK, pneumatic dissection can be achieved through a modified DALK technique with a low risk of complications and excellent visual and refractive outcomes.

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