J Korean Ophthalmol Soc.  2008 Feb;49(2):222-229. 10.3341/jkos.2008.49.2.222.

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus

• Kim KH
• Ahn K
• Chung ES
• Chung TY

• KMID: 2127112
• DOI: http://doi.org/10.3341/jkos.2008.49.2.222

Abstract

PURPOSE: To compare the therapeutic outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) in patients with keratoconus.
METHODS
We retrospectively reviewed the clinical records of 57 patients diagnosed with keratoconus who had undergone DALK (19 eyes of 19 patients) and PKP (38 eyes of 38 patients) in Samsung medical center between January 1995 and January 2006.
RESULTS
The 19 and 38 patients with keratoconus who underwent DALK and PKP had mean ages of 25.3 (range: 17-46) and 26.2 (range: 12-51) years, respectively. These groups were followed up for mean times of 16.7 (range: 6-34) and 45.7 (range: 6-115) months after surgery, respectively. The DALK group showed significantly higher values of refractive power, central corneal thickness, and endothelial cell density, while two eyes (10.5%) in the DALK group developed stromal rejection, which resolved after steroid therapy. In the PKP group, eight eyes (21%) developed endothelial rejection, among whom one eye (2.6%) resulted in a graft failure of a patient who underwent re-PKP, and two eyes (5.3%) in the PKP group developed secondary glaucoma.
CONCLUSIONS
DALK should be considered as the primary surgical technique in keratoconus, because the visual outcome is comparable with PKP and it reduces severe complications such as secondary glaucoma and the risk of graft failure by preserving the corneal endothelium compared to PKP.

Keyword

Deep anterior lamellar keratoplasty; Endothelial cell density; Keratoplasty; Keratoconus; Penetrating

MeSH Terms

Corneal Transplantation
Endothelial Cells
Endothelium, Corneal
Eye
Glaucoma
Humans
Keratoconus
Keratoplasty, Penetrating
Rejection (Psychology)
Retrospective Studies
Transplants

Figure

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  Figure 1. Change of logMAR best-corrected visual acuity (BCVA) after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP). Mean BCVA preoperatively and up to the last follow-up after DALK (pink) and PKP (black) was provided. There were no statistical differences in BCVA between DALK and PKP groups throughout the observational period (Mann Whitney test).

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  Figure 2. Difference of postoperative endothelial cell density between DALK (1958.6±455.1) and PKP (1390.4±460.2) group (p=0.01, Mann Whitney test). Specular microscopy was performed at median times of 26.0 months (DALK group) and 30.5 months (PKP group) postoperatively.

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  Figure 3. Difference of postoperative central corneal thickness between DALK (553.9±44,4) and PKP (506.7±77.4) group (p=0.04, Mann Whitney test). Pachymetry was performed at median times of 26.0 months (DALK group) and 30.5 months (PKP group) postoperatively.

Reference

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