Visual acuity outcomes after deep anterior lamellar keratoplasty: a case-control study. Issue 10 (9th September 2010)

• Record Type: Journal Article
• Authors: Tan, D T H; Anshu, A; Parthasarathy, A; Htoon, H M
• Is Part Of: British journal of ophthalmology. Volume 94:Issue 10(2010)
• Page Start: 1295
• Page End: 1299
• Publication Date: 2010-09-09
• Subjects: Anterior lamellar keratoplasty -- big bubble technique -- keratoconus -- Descemet's membrane -- penetrating keratoplasty -- cornea; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjo.2009.167528
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aim: To compare visual outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK). Secondarily to compare refractive outcomes, complications and graft survival between the three cohorts. Methods: Retrospective case-control study evaluating visual acuity outcomes (VA) following DALK with complete Descemet's baring (DALKa) (modified Anwar big bubble technique—51 eyes), pre-descemetic anterior lamellar keratoplasty (DALKm) (manual technique—52 eyes) and PK (103 eyes) with mean follow-up of 13.6, 19.3 and 18.6 months, respectively. Results: The common indications for surgery were corneal scars (36.4%), keratoconus (28.6%) and corneal dystrophies (13.6%). A best-corrected VA of 6/7.5 or better was achieved in 19.4% (PK), 21.6% (DALKm) and 38.5% (DALKa) of cases (p=0.02), and eyes that underwent DALKa had significantly better visual outcomes than PK (p=0.03). Complications following PK were glaucoma (15%), endothelial rejection (12%) and epithelial problems (11%); in the lamellar group, glaucoma (9%), epithelial problems (5%) and Descemet's detachment (3%) were more common. The 2-year estimated probability of graft survival was 90% for PK, 98% for DALKm and 100.0% for DALKa (p=0.35). Conclusions: Lamellar keratoplasty with complete baring of the Descemet's membrane (DALKa) gave significantly better visual outcomes compared to PK or pre-descemetic ALK and should be the preferred from of corneal replacement in corneal disorders with healthy endothelium.