Comparative analysis of clinical and functional outcomes of deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus patients

Abstract

ABSTRACT Purpose. To evaluate outcomes of surgical treatment of patients with keratocunus using the technique of deep anterior lamellar keratoplasty (DALK) by the aero-viscoseparation of Descemet’s membrane method in a comparative aspect to results of penetrating keratoplasty (PKP). Material and methods. The investigated group included 100 patients (107 eyes) with keratoconus III-IV using the DALK (76 eyes of 70 patients) and the PKP (31 eyes of 30 patients). Preand post-operatively the standard and special diagnostic methods were used (keratotopography, keratopachymetry, anterior segment optical coherence tomography, confocal microscope). The follow-up period was 2 years. Results. Perforation of Descemet’s membrane was a specific intra-operative complication in the main group (10.5%), but converting surgical technique to PKP was required only in 2.6% of cases. Endothelial cell loss 2 years after surgery was 13.6% in the DALK group and 30.8% – in the PKP group (p<0.05). A clear graft retention was observed in 100% of cases in the DALK group and in 93.5% of cases in the PKP group 24 months after surgery and the best corrected visual acuity (BCVA) was 0.74±0.1 (the main group) and 0.56±0.2 (the control group) (p<0.05). Conclusions. The DALK with the aero-viscoseparation of Descemet’s membrane shows better results of visual rehabilitation of patients and a significantly lower alteration of endothelial cell layer, what substantiates its clinical advantages compared to the PKP.

Keywords

• keratoconus
• penetrating keratoplasty
• lamellar keratoplasty
• endothelial cell density
• visual acuity
• astigmatism.