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Philippe Attal, Marc Muraine; Long-term Outcomes Of Deep Anterior Lamellar Keratoplasty In Keratoconus. Invest. Ophthalmol. Vis. Sci. 2011;52(14):786.
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Keratoconus is a slowly progressive disease and slimming of the cornea. In advanced cases, only a corneal graft may improve visual acuity. The traditional penetrating keratoplasty is gradually giving way to the deep anterior lamellar keratoplasty techniques intended to reduce the endothelial trauma and the risk of rejection. Deep anterior lamellar keratoplasty is a recent technique adopted in our team 10 years ago. The aim of our study is to report the results in the long term, a concept at present unknown.
It is a single-center retrospective study which includes 42 eyes of 35 patients operated on between 2000 and 2004. We formed three groups: group 1 (n = 23): Deep anterior lamellar keratoplasty big bubble type, group 2 (n = 8): Deep anterior lamellar keratoplasty by progressive dissection or by viscodissection and group 3 (n = 11): penetrating keratoplasty.
The average age was 35 + / -11 years. The mean follow-up is 7.3 + / - 1.4 years. We noted an increase of the visual acuity in the 3 groups (p <0.001). In the long term, visual acuity was 20/30 + / -20/100 in groups 1 and 2 and 20/40 + / -20/100 in group 3. Astigmatism long-term average is 2.3 + / - 1.2 D, 2.5 + / - 1.2 D and 3.9 + / - 1.9 D, respectively in groups 1, 2 and 3 . Endothelial cell densities are long-term averages from 1760 + / - 461, 1759 + / - 580 and 827 + / - 252 cells / mm ² respectively in groups 1, 2 and 3. Two rejection episodes were noted in patients of group 1 and 3.
Deep anterior lamellar keratoplasty preserves endothelial cell density and sustains long-term viability of the graft . Refractive results are comparable to those in the short term of penetrating keratoplasty but astigmatism is significantly more stable long term in the group of lamellar surgery. We report a stable endothelial cell density and astigmatism over 7 years after deep anterior lamellar keratoplasty. This reinforces the value of this technique in patients with advanced keratoconus.
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