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M. A. Di Pascuale, O. Muftuoglu, V. V. Mootha; Factors Affecting Visual Outcome in Deep Anterior Lamellar Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2009;50(13):620.
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Compared with penetrating keratoplasty, deep anterior lamellar keratoplasty (DALK) has several potential advantages: decreased allograft rejection, reduced complications associated with "open sky" surgery, earlier sutures removal, and less risks for wound dehiscence. Despite these benefits, patients after DALK often show decreased best corrected visual acuity as a result of irregular astigmatism, scarring at the donor-to-recipient interface or other factors not yet known. The purpose of this study is to investigate the factors Affecting Visual Outcome in Deep Anterior Lamellar Keratoplasty (DALK).
We retrospectively reviewed the clinical chart of patients after DALK. Anterior- posterior surface topography, high order aberrations (HOAs), and anterior chamber depth data were evaluated by the Scheimpflug rotating imaging system (Pentacam, Oculus Gmbh, Wetzlar, Germany), and the residual recipient corneal thickness and the donor corneal thickness were evaluated by anterior segment OCT Visante OCT system (VisanteTM OCT; Carl Ziess Meditec Inc., Dublin, California, USA.
We included 14 eyes from 14 patients; mean age was 43.8±16 years, 4 were females and 9 males, with pre-operative diagnosis of keratoconus in 7 eyes, anterior corneal stroma scars in 5 eyes, and corneal dystrophy in 2 eyes. Patients were follow-up for 11.2±6.4 months. Preoperative BCVA significantly improved from 1.29±0.55 to last visit 0.67±0.5, (P= 0.003). Preoperatively scars involved 20% to 70 % of anterior corneal stroma. In all cases, residual recipient stroma was barely detectable by slit lamp examination. Post-operative astigmatism was 5.1±2.1 D, anterior HOAs (coma was -0.678±1.2, spherical aberration was 0.271±1.555) and posterior HOAs (coma was 0.358±2.574 and spherical aberration was 0.581±2.102). The residual corneal thickness was 126.5±58.7 µm and anterior stromal graft thickness was 584.5±38.9 µm. There were not significant correlations after comparing the last visit BCVA with the following factors: post-operative astigmatism, residual-recipient corneal thickness, anterior-posterior HOAs, (P>0.05).
Even though patient’s BCVA significantly improved after DALK, the graft-recipient corneal changes determined by using scheimpflug rotating imaging system and anterior segment OCT showed that anterior-posterior HOAs and residual- donor corneal thickness were no correlate with the visual outcome in patients with DALK.
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