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Ophthalmology. 2012 Feb;119(2):249-55. doi: 10.1016/j.ophtha.2011.07.057. Epub 2011 Nov 4.

Long-term results of deep anterior lamellar versus penetrating keratoplasty.

Author information

1
Centre Hospitalier National d’Ophtalmologie des XV-XX, 28 rue de Charenton, 75012 Paris, France. vincent.borderie@upmc.fr

Abstract

OBJECTIVE:

To compare deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in eyes with corneal diseases not involving the corneal endothelium (keratoconus, scars after infectious keratitis, stromal dystrophies, and trauma).

DESIGN:

Retrospective, comparative case series.

PARTICIPANTS:

One hundred forty-two consecutive DALK (DALK group; big-bubble technique or manual lamellar dissection using a slitlamp) and 142 matched PK (PK group).

METHODS:

Three models were used to describe the postoperative outcomes of the endothelial cell density. A joint regression model was used to predict long-term graft survival. Visual acuity, ultrasound pachymetry, specular microscopy, and optical coherence tomography (OCT) findings were recorded.

MAIN OUTCOME MEASURES:

Postoperative endothelial cell loss and long-term predicted graft survival.

RESULTS:

The average 5-year postoperative endothelial cell loss was -22.3% in the DALK group and -50.1% in the PK group (P<0.0001). The early- and late-phase annual rates of endothelial cell loss were -8.3% and -3.9% per year, respectively, in the DALK group and -15.2% and -7.8% per year in the PK group (P<0.001; biphasic linear model). The median predicted graft survival was 49.0 years in the DALK group and 17.3 years in the PK group (P<0.0001). The average visual acuity was lower in the manual dissection subgroup compared with the PK group (average difference, 1.0 to 1.8 line) and with the big-bubble subgroup (average difference, 2.2 to 2.5 lines). The average central corneal thickness at 12 months was 536 μm in the PK group, 523 μm in the big-bubble subgroup, and 562 μm in the manual dissection subgroup (P<0.001). The average thickness of the residual recipient stroma measured by OCT was 87±26 μm in the manual dissection subgroup. No correlation was found between this figure and logarithm of the minimal angle of resolution at any postoperative time point (P>0.05).

CONCLUSIONS:

Long-term, model-predicted graft survival and endothelial densities are higher after DALK than after PK. The big-bubble technique gives better results than manual dissection and PK. Compared with PK, manual dissection provides higher survival of both the corneal endothelium and graft, but lower visual acuity.

PMID:
22054997
DOI:
10.1016/j.ophtha.2011.07.057
[Indexed for MEDLINE]

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