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

PurposeTo review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique.MethodsIn this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications.ResultsA standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies.ConclusionAlthough there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.

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“… 48 DALK provides good long-term visual outcome for the patients with herpetic keratitis, keratoconus, stromal scars and corneal dystrophies. 49 …”

Section: Resultsmentioning

confidence: 99%

Deep anterior lamellar keratoplasty: A surgeon's guide

Nanavaty

Vijjan

Yvon

2018

Journal of Current Ophthalmology

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“…Its indications have broadened to include not only routine keratoconus, post-infectious leukoma, and stromal dystrophies, but also serious infective keratitis refractory to medical treatment, keratoconic eyes with history of previous hydrops, descemetocele, and keratoglobus. 5,[9][10][11][12][13][14] Several studies report good outcomes of DALK performed in eyes affected by keratoconus with history of corneal hydrops, demonstrating that the presence of a break into the DM is not an absolute contraindication for DALK. 9 Additionally, it has been also demonstrated that intraoperative unexpected DM ruptures may be mended with good results.…”

Section: Discussionmentioning

confidence: 99%

Deep anterior lamellar keratoplasty for corneal penetrating wounds

Sarnicola

Cheung

et al. 2021

European Journal of Ophthalmology

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Purpose: To report our surgical experience of deep anterior lamellar keratoplasty (DALK) performed in eyes with scarring resulting from a corneal penetrating wound without tissue loss. Methods: Case series of three eyes of three patients that underwent DALK for poor vision due to a scar resulting from a previous corneal penetrating wound. Surgery was performed at least 1 year after the initial injury. Manual dissection technique was used in all cases. Preoperative and postoperative best correct visual acuity (BCVA), postoperative residual bed thickness, and postoperative endothelial cell count (ECC) were evaluated. Results: Preoperative BCVA ranged from 1.3 to 1.0 LogMAR. Two eyes were pseudophakic and one eye had a traumatic cataract. Manual DALK was successfully accomplished in all three cases. The mean residual recipient bed thickness was 103 µm (range 68–130 µm). The mean endothelial cell loss at the 6th month of follow-up was 6% (range 3%–11%) with a further 1% decrease at 4 years. One of the patients underwent cataract surgery and limbal relaxing incisions 1 year after DALK having a total endothelial cell loss of 4.8% at 2 years of follow-up. BCVA at 2 years of follow-up was 0.1 LogMAR (range 0.22–0.0 LogMAR). No episode of rejection was recorded, and all grafts remained clear at last follow-up (5 years, range 4–6 years). Conclusions: Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.

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“…Glaucoma is a serious complication after corneal transplantation that can lead to permanent loss of vision. The incidence of glaucoma varies among surgical procedures; for example, it has been calculated to be 9% to 35% after penetrating keratoplasty (PKP), 1 – 4 0% to 4.5% after anterior lamellar keratoplasty (ALK), 5 – 7 and 2% to 14% after endothelial keratoplasty (EK). 8 – 12 The trends of increases in postoperative transient intraocular pressure (IOP) also vary among these procedures: 29% to 80% after PKP, 17% to 36% after ALK, and 31% to 60% after EK.…”

Section: Introductionmentioning

confidence: 99%

Aqueous Cytokine Levels Are Associated With Progression of Peripheral Anterior Synechiae After Descemet Stripping Automated Endothelial Keratoplasty

Kusano

Yamaguchi

Nishisako

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose To evaluate the association between total protein and cytokine levels in aqueous humor (AqH) and the progression of peripheral anterior synechiae (PAS) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This prospective study included 146 consecutive patients who underwent DSAEK. Preoperative levels of total protein and 20 cytokines in AqH were measured. Using three-dimensional anterior segment optical coherence tomography, we assessed the iridotrabecular contact (ITC) area before and at 3, 6, and 12 months after DSAEK. Correlations between the total protein and cytokine levels in the AqH and ITC area were analyzed. Results ITC was observed in 47 eyes (32.2%) after DSAEK. The ITC area increased from 2.00 ± 4.42 mm 2 preoperatively to 3.00 ± 6.85 mm 2 at 12 months. The total protein level in AqH was significantly higher in eyes with ITC progression than in those without (1.45 ± 1.03 mg/mL vs. 1.00 ± 0.57; P = 0.04) and was significantly positively correlated with the progression of ITC area after DSAEK (at 6 months, r = 0.311 and P = 0.005; at 12 months, r = 0.342 and P = 0.0004). The ITC area at 12 months was significantly correlated with the preoperative AqH levels of interleukin-8 ( r = 0.252; P = 0.021), interferon-γ ( r = 0.318; P = 0.009), and soluble intercellular adhesion molecule-1 ( r = 0.292; P = 0.004). Multivariate analyses showed that the total protein levels in AqH and the presence of preoperative ITC were significant risk factors for increased ITC area after DSAEK (β = 0.193–0.574; all P < 0.02). Conclusions Higher preoperative total protein and specific cytokine levels in AqH were associated with ITC formation after DSAEK. Translational Relevance Our findings indicate that chronic pathological changes in AqH can cause PAS progression and glaucoma after DSAEK.

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

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

Cited by 29 publications

References 25 publications

Deep anterior lamellar keratoplasty: A surgeon's guide

Deep anterior lamellar keratoplasty: A surgeon's guide

Deep anterior lamellar keratoplasty for corneal penetrating wounds

Aqueous Cytokine Levels Are Associated With Progression of Peripheral Anterior Synechiae After Descemet Stripping Automated Endothelial Keratoplasty

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