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S. Shimmura, M. Omoto, T. Kawakita, J. Shimazaki, K. Tsubota; Long-Term Results of Deep Anterior Lamellar Keratoplasty (DALK) in Ocular Surface Disease. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1967.
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To report the long-term results of deep anterior lamellar keratoplasty (DALK) performed with or without stem cell transplantation for ocular surface disease with stromal opacification.
A retrospective evaluation was done on 13 eyes of 12 patients with Stevens Johnson syndrome (SJS: 3 eyes), ocular cicatricial pemphigoid (OCP: 2 eyes), thermal burns (2 eyes), trachoma (2 eyes), gelatinous drop-like dystrophy (1 eye) and limbal deficiency of unknown etiology (2 eyes). All cases were followed for more than 12 months. Six eyes with total limbal deficiency underwent simultaneous limbal transplantation at the time of DALK surgery. Phacoemulsification for cataract was done in 4 eyes following DALK.
Nine eyes maintained corneal epithelium after 12 months, and visual improvement of 2 or more lines was observed in 10 out of 13 eyes. Two eyes had a corrected visual acuity of more than 20/200 despite conjunctivalization of the ocular surface. Two of the Sjs cases suffered persistent epithelial defects, with 1 case requiring a penetrating keratoplasty following perforation of the ulcer. No cases of secondary glaucoma were observed.
While careful patient selection is required, DALK with or without limbal transplantation is an effective means to treat patients with stromal opacification following ocular surface disease.
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