Deep anterior lamellar Keratoplasty

Graft survival rate of deep anterior lamellar keratoplasty for keratoconus: A meta-analysis

BACKGROUND

Deep anterior lamellar keratoplasty (DALK) is an optional treatment for patients with keratoconus, and the associated graft survival rate varies. Herein, we aimed to explore the graft survival rate of DALK in patients with keratoconus.

METHODS

PubMed, Web of Science, and ProQuest databases were searched to retrieve the related articles. General data, clinical characters, and graft survival rates were obtained directly from the included studies and analyzed by meta-analysis.

RESULTS

A total of 12 articles were included. The merged 1-, 3-, and 5-year graft survival rates were 100% (99.9-100%, P < .001), 92.9% (89.8-95.9%, P < .001), and 90.4% (86.0-0.948%, P < .001), respectively. Lower heterogeneity was shown in each subgroup that was divided neither according to the sample number nor number of surgeons.

CONCLUSION

The survival rate slightly decreases year by year, but the overall trend seems relatively stable. Ensuring that all DALK procedures are performed by a single surgeon might be helpful to improve the graft survival rate after surgery.

Aetiology-specific comparison of long-term outcome of deep anterior lamellar keratoplasty for corneal diseases

AIMS

To evaluate the long-term outcome of deep anterior lamellar keratoplasty (DALK) for the treatment of herpetic keratitis, keratoconus, stromal scars and corneal dystrophies.

METHODS

This retrospective consecutive case study includes 275 consecutive eyes of 254 patients who underwent DALK; 35 eyes with herpetic keratitis, 114 eyes with stromal scar, 93 eyes with keratoconus and 67 eyes with corneal dystrophy. Exclusion criteria included therapeutic DALK for the treatment of descemetocele or infectious keratitis, and eyes with limbal stem cell deficiency. Patients were examined at 1, 3 and 6 months, and 1, 3 and 5 years after DALK. Graft survival rate, best corrected visual acuity (BCVA), endothelial cell density (ECD) and postoperative complications were evaluated.

RESULTS

The mean postoperative follow-up duration was 51±41 months. The graft survival rate of all subjects was 96.8% at 1 year, 89.9% at 3 years, 83.5% at 5 years and 74.1% at 10 years. At 6 months, BCVA significantly improved from 1.14±0.54 to 0.22±0.21 in the keratoconus group, from 1.13±0.60 to 0.44±0.54 in the herpes group, from 1.00±0.59 to 0.49±0.38 in the stromal scar group and from 1.04±0.52 to 0.32±0.29 in the corneal dystrophy group (all, p<0.0001). BCVA stabilised after 6 months thereafter up to 5 years. ECD decreased just after DALK and maintained >1000 cell/mm(2) at 5 years in all groups.

CONCLUSIONS

DALK provides good visual acuity with slight ECD decrease over long term in all groups.