Early Transitioning to Deep Anterior Lamellar Keratoplasty (DALK)

Abstract

Purpose: : To gain a better understanding of an experienced corneal surgeon’s learning curve when transitioning from penetrating keratoplasty (PK) to deep anterior lamellar keratoplasty (DALK) and compare the clinical success to the literature.

Methods: : A retrospective chart review of all eyes undergoing DALK by one surgeon was reviewed. The clinical and anatomic success was documented and compared to the literature with more experienced surgeons in the DALK technique.

Results: : Eighteen eyes were reviewed. Twelve of the 18 patients were male and 6/18 were female. The average age was 35. The indication for surgery in 16/18 eyes was keratoconus. One patient had lattice dystrophy and 1 patient had a HSV scar. The overall conversion rate to PK at the time of surgery was 50% (9/18). This is in comparison to a conversion rate of approximately 15% in the literature. After the first 6 cases were completed, our conversion rate decreased to 25%. After the first 8 cases were completed, our conversion rate dropped to 20%. Average best corrected visual acuity at the end of follow up was ~ 20/45 as compared to about 20/40 or better reported in the literature.

Conclusions: : DALK is a safe alternative to PK. While there is a learning curve during the transition period from PK to DALK, in our series it nears the published average in the literature after 8 cases.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • cornea: clinical science • anterior segment