Purchase this article with an account.
Loïc Bourmault, Germain Barreau, Juliette Delmas, Jean-Paul Adenis, Pierre-Yves Robert; Deep anterior lamellar keratoplasty versus penetrating keratoplasty in keratoconus. A single center retrospective study of 47 cases.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3132.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The aim of our study was to compare the best corrected visual acuity (BCVA) at 12 months post-operative after penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) in patients operated from keratoconus. The rate of survival of corneal transplants after PKP and DALK was also evaluated.
We retrospectively reviewed the files of 47 eyes of 43 patients operated from keratoconus from 2000 to 2012 (37 DALK and 10 PKP). For DALK we used the "big bubble" technique, viscodissection or association of the two (aeroviscodissection) .The DALK that have presented peroperative macroperforations have been converted in PKP and included in the group of PKP. We analyzed BVCA pre-operative and at 12 months, occurence of complications and the last date when the transplant has been declared clear.
On 37 DALK , there was 1 microperforation and 11 macroperforations of Descemet's membrane leading to conversion to PKP. In total, we performed 26 DALK and 21 PKP on patients respectively 36 ±12 or 34 ±11years old. BVCA increased from 1,01± 0,27 LogMAR preoperative to 0,43±0,27 Log MAR at 12 months in the DALK group, and from 1,11±0,44 Log MAR preoperative to 0,35± 0,25 Log MAR at 12 months in the PKP group. The difference between PKP and DALK gained acuity was not statistically significant .The medium follow-up was longer for the PKP (52,5±41 months) than for the DALK (30 ±27 months)(p=0,047). The rate of graft survival was 80,77% at 3 years for the DALK and 100% for the PKP. In both groups, the most common complications were immune release, ocular hypertony, Urrets-Zavalia's syndrome, cataract, edema and suture problems. We reported in the DALK group 2 cases of clouding of the interface, and 3 cases of anterior double-chamber requiring further PKP.
The most frequent occurence of per and post operative complications in DALK limited graft survival. However, we observed a decrease of peroperative perforations of the Descemet's membrane with time, showing a long learning curve for this procedure. Both DALK and PKP give good results on visual acuity. Graft survival is better after DALK than PKP on a very long term because there is a risk of endothelial rejection or natural loss of endothelial cells. Therefore DALK may be considered as the treatment of choice in keratoconus when a keratoplasty is required.
This PDF is available to Subscribers Only