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Sonali D. Tarafdar, Douglas Lyall, Michael J. Gilhooley, Fiona Roberts, Kanna Ramaesh; Long-term Visual Outcomes, Graft Survival and Complications of Deep Anterior Lamellar Keratoplasty in Patients with Herpes Simplex Related Corneal Scarring. Invest. Ophthalmol. Vis. Sci. 2012;53(14):14. doi: https://doi.org/.
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To report long term visual outcomes, complications and graft survival of patients undergoing deep anterior lamellar keratoplasty (DALK) to treat corneal scarring secondary to herpes simplex virus (HSV) keratitis
Retrospective non-comparitive case series. 18 patients who underwent DALK for HSV keratitis related corneal scarring between January 2004 and February 2007 were included. DALK was performed by Anwar’s big bubble technique with the lamellar graft being secured by interrupted sutures in all cases. Data on pre-operative characteristics, intra-operative complications and post-operative acuity, complications and subsequent operations were collected for analysis.
27% of patients with more than four years follow up had a best corrected distance visual acuity (BDVA) of 6/12 or better and 64% had a BDVA of 6/24 or better. This is compared to 9% and 18% respectively pre-operatively. Six patients (33%) experienced a recurrence of HSV keratitis and 9 (50%) experienced and episode of graft rejection. There were five cases (28%) of graft failure, four of whom had had a previous episode of graft rejection. The other four cases of rejection resolved with either topical or systemic corticosteroid therapy. Logistic regression did not find an association with graft rejection, HSV recurrence, any other observed post-operative complication and eventual graft failure. There was no relationship found between superficial or deep host corneal vascularisation and any post-operative complication. The majority of patients underwent a secondary operation with 50% requiring cataract extraction and intraocular lens implantation.
DALK for the treatment of HSV related corneal scarring is associated with a high percentage of post-operative complications. With adequate treatment, this does not necessarily lead to graft failure. DALK in this context is also associated with a large percentage of secondary operations. Patients should be aware of this when giving informed consent for DALK.
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