Deep Anterior Lamellar Keratoplasty in Acanthamoeba Keratitis
Narrative Responses:
Purpose
To report our experience with DALK in Acanthamoeba infection.
Methods
Retrospective, consecutive, non comparative cases series report of DALK in 12 eyes of 11 patients with previous diagnosis of Acanthamoeba keratitis. Inclusion criteria were: unchanged preop and postop anti-amoebic therapy (Chlorhexidina Gluconate, Propamidine Isethionate, Neomycin Sulfate), same surgeon, and 2 years follow-up. DALK procedure was performed in 9 eyes with controlled infection and in 3 eyes with active infection resistant to therapy. Donor and recipient diameters were the same and as large as possible (8.5 - 9.0 mm). Graft was sutured with 18 single interrupted sutures. Pathological examination of the removed lamellae was done.
Results
Nine descemetic DALK (dDALK) and 3 predescemetic DALK (pdDALK) were obtained. No Descemet’s ruptures occurred. There were no conversions to PK. Postoperative therapeutic protocol with anti-amoebic agents was prescribed. No episodes of rejection or recurrence of infection were detected at the last follow up. No other complications were recorded. BSCVA average was 17/20 (range 14-20/20).
Conclusion
DALK is a good procedure to restore vision in cases with significant corneal scarring. It should also be considered as an early indication for cases with active infection that don't respond to medical therapy, with the advantages of reduced risks of intraocular spread of infection, rejection and graft failure.