Document Detail

Long-term results of deep anterior lamellar versus penetrating keratoplasty.
MedLine Citation:
PMID:  22054997     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in eyes with corneal diseases not involving the corneal endothelium (keratoconus, scars after infectious keratitis, stromal dystrophies, and trauma).
DESIGN: Retrospective, comparative case series.
PARTICIPANTS: One hundred forty-two consecutive DALK (DALK group; big-bubble technique or manual lamellar dissection using a slitlamp) and 142 matched PK (PK group).
METHODS: Three models were used to describe the postoperative outcomes of the endothelial cell density. A joint regression model was used to predict long-term graft survival. Visual acuity, ultrasound pachymetry, specular microscopy, and optical coherence tomography (OCT) findings were recorded.
MAIN OUTCOME MEASURES: Postoperative endothelial cell loss and long-term predicted graft survival.
RESULTS: The average 5-year postoperative endothelial cell loss was -22.3% in the DALK group and -50.1% in the PK group (P<0.0001). The early- and late-phase annual rates of endothelial cell loss were -8.3% and -3.9% per year, respectively, in the DALK group and -15.2% and -7.8% per year in the PK group (P<0.001; biphasic linear model). The median predicted graft survival was 49.0 years in the DALK group and 17.3 years in the PK group (P<0.0001). The average visual acuity was lower in the manual dissection subgroup compared with the PK group (average difference, 1.0 to 1.8 line) and with the big-bubble subgroup (average difference, 2.2 to 2.5 lines). The average central corneal thickness at 12 months was 536 μm in the PK group, 523 μm in the big-bubble subgroup, and 562 μm in the manual dissection subgroup (P<0.001). The average thickness of the residual recipient stroma measured by OCT was 87±26 μm in the manual dissection subgroup. No correlation was found between this figure and logarithm of the minimal angle of resolution at any postoperative time point (P>0.05).
CONCLUSIONS: Long-term, model-predicted graft survival and endothelial densities are higher after DALK than after PK. The big-bubble technique gives better results than manual dissection and PK. Compared with PK, manual dissection provides higher survival of both the corneal endothelium and graft, but lower visual acuity.
Vincent M Borderie; Otman Sandali; Julien Bullet; Thomas Gaujoux; Olivier Touzeau; Laurent Laroche
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-11-04
Journal Detail:
Title:  Ophthalmology     Volume:  119     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-06     Completed Date:  2012-03-22     Revised Date:  2013-02-12    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  249-55     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Centre Hospitalier National d’Ophtalmologie des XV-XX, 28 rue de Charenton, 75012 Paris, France.
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MeSH Terms
Astigmatism / physiopathology
Cell Count
Corneal Diseases / physiopathology,  surgery*
Corneal Endothelial Cell Loss / physiopathology
Corneal Transplantation*
Endothelium, Corneal / pathology
Follow-Up Studies
Graft Survival / physiology
Keratoplasty, Penetrating*
Microscopy, Acoustic
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome
Visual Acuity / physiology
Comment In:
Ophthalmology. 2013 Jan;120(1):216   [PMID:  23283193 ]
Ophthalmology. 2013 Jan;120(1):216-7   [PMID:  23283194 ]

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