Evaluation of Corneal Surface after Penetrating Keratoplasty (PK) and Deep Anterior Lamellar Keratoplasty (DALK).

Abstract

Purpose : To compare early corneal staining after Penetrating Keratoplasty (PK) and Deep Anterior Lamellar Keratoplasty (DALK) for corneal stromal diseases.

Methods : Prospective, consecutive, longitudinal, case series/cohort study of patients operated corneal transplant with both PK and DALK. All patients have stromal disease. We compared early corneal staining at months 1 and 3 after keratoplasty. All patients were using lubricant drops and standard keratoplasty medication. Corneal staining with fluorescein registered on files was classified according to Oxford score from 0-5. Outcomes are expressed as mean (standard deviation, SD) for all.

Results : We evaluated 50 eyes after keratoplasty, 28 (56%) PK and 22 (44%) DALK. All patients had stromal disease and were distributed as follow (PK / DALK): keratoconus 11(39.3%) / 10 (45.5%), corneal scar secondary to trauma or microbial keratitis 15 (53.6%) / 7 (31.8%), corneal scar secondary to Herpes Virus Simple keratitis 1 (3.6%) / 1 (4.5%) and Others 1 (3.6%) / 4 (18.2%). Mean age (SD) was 38.25 (22.11) and 25.90 (14.09) years respectively. Mean (SD) corneal staining in PK and DALK at first month were 1.55 (1.37) and 0.81 (0.95); and at third month were 0.93 (1.30) and 0.68 (0.94) respectably. Oxford corneal staining was statistically more severe in PK than DALK only at first month (p=0.037) but similar at third month (p=0.453).
According to baseline disease, in keratoconus cornea staining was less in DALK (0.70 ±0.83) than in PK: 1.18 ±1.25). In corneal scar secondary to trauma or microbial keratitis cornea staining was less in DALK (0.57 ±1.13) than in PK (1.73 ±1.53). In Other diseases (stromal dystrophy, radial keratectomy, ectasia post LASIK) cornea staining was less in DALK (1.25 ±0.95) than in PK (2.00 ±0.00) and in the only 1 case of Corneal scar secondary to Herpes Virus Simple Keratitis PK stained less (1.00 ±0.00) than DALK (2.00 ±0.00).

Conclusions : We found in this group of patients that DALK had less corneal staining than PK at first month and similar corneal staining at three months after surgery. Including both groups keratoconus was the disease that showed less corneal staining.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.