Clinical Results of Deep Anterior Lamellar Keratoplasty

Kim, Mi Rang; Chung, Eui Sang

Abstract

PURPOSE
To evaluate the surgical outcome of deep anterior lamellar keratoplasty (DALKP) in patients with corneal opacity with an intact corneal endothelium. METHODS: We transplanted partial thickness donor cornea, devoid of endothelium and Descemet's membrane, on to a recipient bed of which the deep stromal area had been dissected to expose the smooth surface of Descemet's membrane. We evaluated the visual acuity, refractive error, endothelial cell density, intraocular pressure, complication and graft rejection after a follow-up period of at least 6 months. RESULTS: Twelve eyes of 11 patients (M: F=7: 4) were enrolled in this study, with a mean age of 39 years (17~60). The mean follow-up period was 9.8 months. The underlying diseases were keratoconus in 6 eyes, corneal dystrophy in 4 and herpetic corneal lesion in 2. The mean postoperative visual improvement was 5 lines of Snellen chart. Microperforations occurred during operation in 4 eyes, and were treated with intracameral gas injection. One of them underwent penetrating keratoplasty due to persistent double anterior chamber. Transient elevation of intraocular pressure was noted in 7 eyes, but no case of graft rejection was observed during the follow-up period. CONCLUSIONS: Even though intraoperative microperforation may require an additional procedure such as gas injection which increases the possibility of intraocular pressure elevation, deep anterior lamellar keratoplasty is thought to be a good option for the primary surgery in patients with corneal opacity with an intact corneal endothelium due to its relatively fast recovery, reduced risk of rejection and preservation of endothelium without ongoing loss.