Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus.

Abstract

PURPOSE:

To evaluate the long-term endothelial cell density (ECD) changes and visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus.

DESIGN:

Retrospective interventional case series study.

METHODS:

setting: Single hospital. patients: Two hundred forty-one eyes of 214 patients who underwent DALK for moderate to advanced keratoconus. main outcome measures: Intraoperative and postoperative complications, postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, topographic astigmatism, and ECD.

RESULTS:

Two hundred thirty-four procedures (97%) were completed as DALK. Big bubble was successfully achieved in 193 eyes (82.4%). In 7 eyes (3%), the procedure was converted to penetrating keratoplasty because of Descemet membrane macroperforations. Microperforations occurred in 18 eyes (7.5%). The mean follow-up time was 50.5 ± 22.2 months (range 24 to 96 months). UCVA was lower than 20/100 in all eyes preoperatively and better than 20/100 in 191 eyes (81.6%) postoperatively. BSCVA was 20/40 or better in 187 eyes (79.9%) and 20/20 or better in 38 eyes (16.2%). The mean (± SD) preoperative ECD that was possible in 166 eyes was 2797 ± 561 cells/mm(2). Mean (± SD) endothelial cell loss was 8.1% ± 4.6% at 1 year, 10.5% ± 5.7% at 2 years, 15.1% ± 14.8% at 6 years, and 22.5% ± 15.9% at 8 years. Stromal graft rejection episodes occurred in 4 eyes, which resolved with appropriate therapy.

CONCLUSIONS:

Deep anterior lamellar keratoplasty that uses the big-bubble technique is effective in patients with keratoconus. Long-term endothelial cell loss was moderate and lower than penetrating keratoplasty grafts.

• Authors: Anil Kubaloglu, Esin Sögütlü Sari, Mustafa Unal, Arif Koytak, Ekrem Kurnaz, Yasin Cinar, Yusuf Ozertürk
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 151 Issue 5 Pg. 760-767.e1 (May 2011) ISSN: 1879-1891 [Electronic] United States
• PMID: 21333267 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Astigmatism (physiopathology)
• Cell Count
• Child
• Corneal Endothelial Cell Loss (physiopathology)
• Corneal Transplantation
• Endothelium, Corneal (pathology)
• Female
• Follow-Up Studies
• Humans
• Intraoperative Complications
• Keratoconus (physiopathology, surgery)
• Male
• Middle Aged
• Postoperative Complications
• Refraction, Ocular (physiology)
• Retrospective Studies
• Treatment Outcome
• Visual Acuity (physiology)