Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty in Keratoconus Patients
Purpose
To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in keratoconus patients with more than 4 years of postoperative follow-up time.
Methods
Setting/Venue: Single center, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy. Retrospective non-comparative interventional case series. Seventy eyes of 64 consecutive patients with moderate to advanced keratoconus intolerant to contact lenses with corrected distance visual acuity (CDVA)! 20/40 who underwent Big-bubble or manual DALK between 2003 and 2008 and had a post-operative follow-up of more than 4 years were included in the study. Intraoperative and postoperative complications, postoperative uncorrected distance visual acuity (UDVA), CDVA, mean refractive spherical equivalent (MRSE), keratometry, endothelial cell density (ECD) and complications were recorded at baseline and final follow-up visit. All values are expressed as mean ± standard deviation.
Results
Mean follow-up was 76.9 ± 23.2(range 48-120) months. Baseline UDVA was 20/400(1.30 ± 1.30 LogMar), CDVA 20/50(0.7 ± 1.0 LogMar), MRSE -10.27 ± 7.14, mean keratometry 60.7 ± 6.1 D, topographic astigmatism 4.73 ± 2.64 D. At the last follow-up visit, UDVA improved to 20/50(0.4 ± 0.6 LogMar), CDVA to 20/25(0.1 ± 0.7 LogMar), MRSE to -2.5 ± 3.5, mean keratometry to 44.5 ± 2.3 D and topographic astigmatism to 2.84 ± 1.52 D. ECD did not vary from pre-operative values(2198 ± 373 vs 2070 ± 367 cell/mm2). 8/70 (11.4 %) eyes developed stromal or epithelial rejection, with 2/70(2.8%) undergoing re-grafting.
Conclusion
DALK provides excellent long-term visual outcomes in patients with keratoconus with lesser complications and ECD decay compared to penetrating keratoplasty.