A Comparison of Lamellar and Penetrating Keratoplasty Outcomes

Corneal Transplant Surgery for Keratoconus and the Effect of Surgeon Experience on Deep Anterior Lamellar Keratoplasty Outcomes

“…3,5,19 Similar to previous reports, including that by Watson and associates, 9,18,20 we also found that a greater proportion of patients achieved 6/6 Snellen visual acuity or better following PKP than DALK, but we found no difference in the proportion of patients with a BCVA of 6/60 or worse. In addition, as has been reported, 9 patients who had undergone DALK tended to have a more myopic refractive error.…”

“…In a similar registry study to this report, Coster and associates found no surgical learning effect on DALK outcomes by stratifying surgeons according to their experience in groups of 10 procedures, as reported in this study. 20 In contrast, Unal and associates reported a lower rate of complications after having undertaken 40-50 DALK using the big bubble technique, and suggested that a relatively greater surgical experience may be required before success rates are improved. 17 We did not, however, find evidence to support this.…”

“…Interestingly, the finding of a surgical learning curve for endothelial keratoplasty, which would be regarded by most experienced surgeons as a less complex procedure than DALK, adds further weight to the suggestion that lamellar procedures may have less predictable outcomes overall. 20,22 The plateau in the uptake of DALK (at least in the United Kingdom) suggests that further work is needed to make DALK more predictable and easier to perform so that its outcome, including the refractive outcome, is consistently superior to PKP. …”

Long-Term Clinical Outcomes of Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus

“…3 Similarly, reports from the United Kingdom, Singapore, and Australia eye banks suggest that the number of DALK procedures has increased gradually during the last 10 years. [4][5][6] Different DALK techniques have been described, based essentially on either manual dissection/delamination of the corneal stroma or separation of the DM 7 from the stroma by means of intrastromal injection of fluid, viscoelastic, or air. 8 The ''bigbubble'' technique applies a forceful injection of air into the deep stroma to obtain cleavage separation of the descemetic/predescemetic plane (Dua layer) 7 from the overlying stroma, with formation of a large air bubble between these 2 layers.…”

Prevalence of keratoconus among refractive surgery candidates Abstract: Background: Reasons for refraining from refractive surgery were numerous, with a change of mind after the pre examination being the most common. Patients who changed their minds were very similar to those who had surgery. World Wide Keratoconus is a comparatively common diseases frequency ranging from 50 to 230 per 100,000. Keratoconus is increasing rapidly in Asir Province, Saudi Arabia and more fastly occurred / create complications

“…This study assessed the prevalence of KC among refractive surgery candidates in Aseer province of Saudi Arabia and we found that The most common reasons for not doing refractive surgery were Keratoconus 126, 24.04%,which is inline with many studies Likewise, it represented the most common indication of keratoplasty in a previous study in Eastern Province, Saudi Arabia, and in studies from other parts of the world; New Zealand (45.60%), Iran (34.51%.42.5%), Australia (29.8%),France (28.80%),15 UK (28.7%), Zimbabwe (26.80%), and Germany (20.90%-25.5%).However, this is inconsistent with other regions where the percentage of keratoconus cases that require keratoplasty showed lower rates in reports from Brazil (13.10%),20 China (13%),21 Canada (12%-15.5%),22-24 and the US (11.40%)2,3 [14][15][16][17][18][19] Keratoplasty services in Saudi Arabia have progressed steadily in parallel with socioeconomic development and population growth in the past few decades.9, The deviation in percentage of keratoconus cases requiring keratoplasty surgery could be rationalized by the variance in the reported prevalence of keratoconus, which varies widely depending upon the genetic factors, geographic location, and diagnostic criteria. Environmental factors such as sunshine and hot weather with excessive ultra-violet exposure have been implicated as a contributing factor in the increased prevalence in the Middle East and India.The incidence and severity of keratoconus in Asir Province in Saudi Arabia has been reported to be high with an early onset and rapid progression.…”