Skip to main content

Advertisement

SpringerLink
Log in

Comparison of outcomes and complications of deep anterior lamellar keratoplasty and penetrating keratoplasty performed in a large group of patients with keratoconus

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To compare visual acuity, refraction, topography, and complications of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) performed in patients with keratoconus (KCN).

Methods

In this retrospective interventional non-randomized clinical study, patients with moderate to severe KCN that underwent either PKP or DALK for optical corrections were enrolled. The final outcome analysis was performed after complete suture removal for both groups of patients. Best corrected visual acuity, spherical equivalent, refractive cylinder, average keratometry, corneal astigmatism, and endothelial cell density as well as early and late complications such as cataract, glaucoma, corneal edema, elevated intraocular pressure without visual field defect or optic disk changes, rejection, loose suture, and re-suturing were compared.

Results

Two hundred and seven eyes were enrolled: 108 eyes underwent DALK, and 99 eyes underwent PKP for keratoconus. The mean follow-up time was 28.06 ± 12.62 months for DALK group and 29.29 ± 12.71 months for PKP. The study groups demonstrated comparable final outcome in terms of best corrected visual acuity: 0.25 ± 0.22 LogMAR and 0.28 ± 0.24 LogMAR (p = 0.415), spherical equivalent: −4.80 ± 4.55D and −3.58 ± 3.58D (p = 0.067), refractive cylinder: −3.37 ± 2.00D and −4.00 ± 2.15D (p = 0.061), average keratometry: 45.51 ± 2.30D and 44.85 ± 2.36D (p = 0.077), corneal astigmatism: 4.89 ± 3.07D and 4.63 ± 2.61D (p = 0.569) in DALK (n = 85) and PKP (n = 72), respectively. However, the postoperative endothelial cell density in DALK (n = 61) 2250 ± 450 cell/mm2 differs significantly from it in PKP (n = 55) 1795 ± 616 cell/mm2 p < 0.001. Eyes that had DALK (n = 99) had significantly more risk of loose suture (RR 5.2) and re-suturing (RR 3.6) than PKP (n = 108). However, the risk of cataract following DALKs was less than PKP (OR 0.4).

Conclusion

The vision, refractive error, and corneal astigmatism following DALK and PKP were comparable; however, DALK had lower incidence of long-term complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Al-Mohaimeed MM (2013) Penetrating keratoplasty for keratoconus: visual and graft survival outcomes. Int J Health Sci (Qassim) 7(1):67–74

    Article  Google Scholar 

  2. Dunn SP, Gal RL, Kollman C et al (2014) Corneal graft rejection 10 years after penetrating keratoplasty in the cornea donor study. Cornea 33(10):1003–1009

    Article  PubMed  PubMed Central  Google Scholar 

  3. Patel SV, Hodge DO, Bourne WM (2005) Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am J Ophthalmol 139:311–319

    Article  PubMed  Google Scholar 

  4. Shimmura S, Tsubota K (2006) Deep anterior lamellar keratoplasty. Curr Opin Ophthalmol 17:349–355

    Article  PubMed  Google Scholar 

  5. Anwar M, Teichmann KD (2002) Deep lamellar keratoplasty: surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet’s membrane. Cornea 21(4):374–383

    Article  PubMed  Google Scholar 

  6. Anwar M, Teichmann KD (2002) Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 28(3):398–403

    Article  PubMed  Google Scholar 

  7. Han DC, Mehta JS, Por YM, Htoon HM, Tan DT (2009) Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol 148(5):744–751

    Article  PubMed  Google Scholar 

  8. Kim MH, Chung TY, Chung ES (2013) A retrospective contralateral study comparing deep anterior lamellar keratoplasty with penetrating keratoplasty. Cornea 32(4):385–389

    Article  PubMed  CAS  Google Scholar 

  9. Zhang YM, Wu SQ, Yao YF (2013) Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus. J Zhejiang Univ Sci B 14(5):438–450

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tan DT, Anshu A, Parthasarathy A, Htoon HM (2010) Visual acuity outcomes after deep anterior lamellar keratoplasty: a case-control study. Br J Ophthalmol 94(10):1295–1299

    Article  PubMed  CAS  Google Scholar 

  11. Claesson M, Armitage WJ, Fagerholm P, Stenevi U (2002) Visual outcome in corneal grafts: a preliminary analysis of the Swedish Corneal Transplant Register. Br J Ophthalmol 86(2):174–180

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Parthasarathy A, Por YM, Tan DT (2007) Use of a “small-bubble technique” to increase the success of Anwar’s “big-bubble technique” for deep lamellar keratoplasty with complete baring of Descemet’s membrane. Br J Ophthalmol 91(10):1369–1373

    Article  PubMed  PubMed Central  Google Scholar 

  13. Feizi S, Faramarzi A, Javadi MA et al (2014) Modified big-bubble deep anterior lamellar keratoplasty using peripheral air injection. Br J Ophthalmol 98(11):1597–1600

    Article  PubMed  Google Scholar 

  14. Sarnicola V, Toro P (2011) Blunt cannula for descemetic deep anterior lamellar keratoplasty. Cornea 30(8):895–898

    Article  PubMed  Google Scholar 

  15. Fontana L, Parente G, Tassinari G (2007) Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am J Ophthalmol 143(1):117–124

    Article  PubMed  Google Scholar 

  16. MacIntyre R, Chow SP, Chan E, Poon A (2014) Long-term outcomes of deep anterior lamellar keratoplasty versus penetrating keratoplasty in Australian keratoconus patients. Cornea 33(1):6–9

    Article  PubMed  Google Scholar 

  17. Ardjomand N, Hau S, McAlister JC, Bunce C, Galaretta D, Tuft SJ, Larkin DF (2007) Quality of vision and graft thickness in deep anterior lamellar and penetrating corneal allografts. Am J Ophthalmol 143(2):228–235

    Article  PubMed  Google Scholar 

  18. Feizi S, Javadi MA, Kanavi MR, Javadi F (2014) Effect of donor graft quality on clinical outcomes after deep anterior lamellar keratoplasty. Cornea 33(8):795–800

    Article  PubMed  Google Scholar 

  19. Price MO, Gorovoy M, Price FW Jr, Benetz BA, Menegay HJ, Lass JH (2012) Descemet’s stripping automated endothelial keratoplasty: three-year graft and endothelial cell survival compared with penetrating keratoplasty. Ophthalmology 120(2):246–251

    Article  PubMed  PubMed Central  Google Scholar 

  20. Harding SA, Nischal KK, Upponi-Patil A, Fowler DJ (2010) Indications and outcomes of deep anterior lamellar keratoplasty in children. Ophthalmology 117(11):2191–2195

    Article  PubMed  Google Scholar 

  21. Cheng YY, Visser N, Schouten JS et al (2011) Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology 118(2):302–309

    Article  PubMed  Google Scholar 

  22. Barry Lee W, Mannis Mark J (2007) Corneal Suturing Techniques. In: Macsai Marian S (ed) ophthalmic microsurgical suturing techniques, 1st edn. Springer, Berlin, pp 49–59

    Google Scholar 

  23. Liu H, Chen Y, Wang P, Li B, Wang W, Su Y, Sheng M (2015) Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: a meta-analysis. PLoS ONE 10(1):e0113332

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Maurino V, Aiello F (2015) Glaucoma risks in advanced corneal surgery. Prog Brain Res 221:271–295

    Article  PubMed  Google Scholar 

  25. Acar BT, Vural ET, Acar S (2011) Changes in endothelial cell density following penetrating keratoplasty and deep anterior lamellar keratoplasty. Int J Ophthalmol 4(6):644–647

    PubMed  PubMed Central  Google Scholar 

  26. Kubaloglu A, Koytak A, Sari ES et al (2012) Corneal endothelium after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus: a four-year comparative study. Indian J Ophthalmol 60(1):35–40

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dhahran Eye Specialist Hospital, Dhahran, 31942-39455, Kingdom of Saudi Arabia

    Ashbala Khattak & Fouad R. Nakhli

  2. Dammam University, Dammam, Kingdom of Saudi Arabia

    Khaled M. Al-Arfaj

  3. Imperial College School of Medicine, London, UK

    Abdullah A. Cheema

Authors
  1. Ashbala Khattak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fouad R. Nakhli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khaled M. Al-Arfaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdullah A. Cheema
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashbala Khattak.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khattak, A., Nakhli, F.R., Al-Arfaj, K.M. et al. Comparison of outcomes and complications of deep anterior lamellar keratoplasty and penetrating keratoplasty performed in a large group of patients with keratoconus. Int Ophthalmol 38, 985–992 (2018). https://doi.org/10.1007/s10792-017-0548-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-017-0548-9

Keywords

Search

Navigation