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Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty

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Abstract

Aims

To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of infection and residual stromal opacity.

Methods

Ten eyes of nine consecutive patients undergoing DALK after DSAEK at a single tertiary referral center (SNEC) from 2011 to 2016 were analyzed for best spectacle-corrected visual acuity (BSCVA), refraction, spherical equivalent (SE) and cylinder, as well as graft diameters, survival, and complications.

Results

The mean pre-DSAEK BSCVA was 1.73 ± 0.76 LogMAR. At a mean follow-up of 9.8 ± 7.1 months, visual acuity had improved significantly (p = 0.028) to 1.09 ± 0.55 LogMAR after DSAEK. DALK was performed at 10.3 ± 7.2 months after DSAEK because of residual stromal scarring in nine and a corneal infection in one case. At the last follow-up visit (19.4 ± 13.9 months) after DALK, BSCVA had improved to 0.38 ± 0.6 LogMAR, significantly better than after DSAEK alone (p = 0.015) and before DSAEK (p = 0.018). Spherical equivalent (− 4.8 ± 3.5 D) and cylinder (− 2.5 ± 2.0 D) did not show significant changes compared to after DSAEK (SE p = 0.17; cylinder p = 0.19) or 3 months after DALK (SE p = 0.17; cylinder p = 0.46). One endothelial graft failed 3 months after DALK. Kaplan-Meier estimated average survival for all cases was 45.3 (95% CI 36.6–54.0) months. The cumulative survival probability for the entire cohort was 90% at 1, 2, and 4 years of follow-up.

Conclusions

DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.

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Author information

Authors and Affiliations

  1. Singapore Eye Research Institute, Singapore, Singapore

    Matthias Fuest, Hla Myint Htoon, Donald Tan & Jodhbir S. Mehta

  2. Department of Ophthalmology, RWTH Aachen University, Aachen, Germany

    Matthias Fuest

  3. Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore

    Sharita R. Siregar, Abdelsattar Farrag, Donald Tan & Jodhbir S. Mehta

  4. Jakarta Eye Center, Jakarta, Indonesia

    Sharita R. Siregar

  5. Eye-ACP, Duke-NUS Graduate Medical School, Singapore, Singapore

    Hla Myint Htoon, Donald Tan & Jodhbir S. Mehta

  6. Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore

    Donald Tan

  7. School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore

    Jodhbir S. Mehta

Authors
  1. Matthias Fuest
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  2. Sharita R. Siregar
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  3. Abdelsattar Farrag
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  4. Hla Myint Htoon
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  5. Donald Tan
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  6. Jodhbir S. Mehta
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Corresponding author

Correspondence to Jodhbir S. Mehta.

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Conflict of interest

Donald Tan and Jodhbir S. Mehta, inventors of the EndoGlide, have financial interests in the device (AngioTech, Reading, Pennsylvania, USA/Network Medical Products, North Yorkshire, UK). Matthias Fuest, Sharita R Siregar, Abdelsattar Farrag, and Hla Myint Htoon certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (SingHealth Centralized Institutional Review Board, R348/06/2004 and R847/42/2011) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Video 1

Technique of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DALK). (MP4 17,947 kb)

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Fuest, M., Siregar, S.R., Farrag, A. et al. Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 256, 1669–1677 (2018). https://doi.org/10.1007/s00417-018-3997-6

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  • DOI: https://doi.org/10.1007/s00417-018-3997-6

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