Comparison of Deep Lamellar Keratoplasty and Penetrating Keratoplasty in Patients With Keratoconus

Abstract

Abstract: : Purpose: The aim of this study was to compare the therapeuticoutcomes for deep lamellar keratoplasty (DLK) and penetratingkeratoplasty (PK) in patients with keratoconus.Methods: A comparativeoutcome study was undertaken. Clinical data was retrieved fromdatabases of 40 patients with keratoconus having DLK (24) orPK (33). This prospectively recorded data was updated from theclinical case notes in order to obtain best corrected visualacuities (VA) and complications.Results: The average age ofthe patients who underwent DLK was 29 yrs (range 14-43)and theaverage follow up was 10 mnths (range 3-25). Patients who underwentPK had an average age of 41 yrs (range 19-63)and an averagefollow-up of 30 months (range 6-165). Patients undergoing DLKhad slightly poorer VA than PK at final follow up (Table 1).However, there was less than one line difference between them.The complications for each group are shown in table 2.Conclusion:PK has been the definitive surgical treatment for keratoconusfor many years. Current techniques for DLK allow a full thicknesscorneal stroma/epithelial button to be placed into a host bedcontaining little or no stromal tissue, on top of Descemet'smembrane. Although PK has the advantage of many years followup and good eventual vision, the structural and immunologicalintegrity of the eye is breached. DLK though more technicallychallenging than PK, eliminates the possibility of endothelialrejection. In our study the therapeutic outcome for patientswith keratoconus undergoing DLK or PK was similar. This is importantas keratoconic patients are usually young and maybe able toavoid the life-long risk of rejection with DLK, if graftingis required. Table 2: Complications of DLK & PK  

Table 1: A comparison of Pre-op and post-op VA after DLK andPK 

Keywords: 353 clinical (human) or epidemiologic studies: outcomes/complications • 450 keratoconus