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L. M. Nielsen, J. P. G. Bergmanson, J. D. Goosey, J. H. Mathew, J. Pass, T. C. Prager, A. Z. Chuang; Clinical Outcomes Comparison of Penetrating Keratoplasty and Lamellar Keratoplasty in Keratoconus. Invest. Ophthalmol. Vis. Sci. 2009;50(13):642.
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Penetrating keratoplasty (PKP) is the most common transplant surgical procedure for keratoconus (Kc). However, lamellar keratoplasty (LKP) may be a better option by removing only the anterior cornea, where this disease is focused in its early stages. Advantages of LKP are preserved global strength, reduced risk of rejection, and shorter healing times. The objective of this case series study was to compare the visual outcomes of PKP and LKP.
This study was the retrospective examination of 100 Kc patients who had surgery performed by one surgeon; 61 had LKP and 13 had PKP. Data were collected from the pre-surgical, 6-, 12-, and 24-month post-surgical visits and analyzed statistically to show any difference between the two surgeries. There was a paucity of baseline data among PKP patients and at 12 months 26 subjects had LKP and 7 had PKP.
There was no statistically significant difference between the two surgeries in post-surgical visual acuity (VA), corneal astigmatism (CA), or spherical equivalent refractive error (RE). The average results reached by 12 months for patients who underwent PKP were: VA of 20/36 (SE: +/- 2.5 letters), CA of 4.37D (+/- 1.236D), and RE of -12.12D (+/- 2.198D). The average results reached by twelve months for patients who underwent LKP were: VA of 20/40 (SE: +/- 1.5 letters), CA of 3.51D (+/- 0.402D), and RE of -8.21D (+/- 1.161D). None of the patients, LKP or PKP, experienced rejection or rejection episodes.
As there was no visual outcome advantage to a patient undergoing PKP for Kc, this small cohort data suggest that LKP should be considered due to its inherent advantages. Because this surgery is more technically challenging, an adequately powered prospective study will be conducted using multiple patients from multiple surgeons to confirm the results reported here.
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