Clinical evaluation of Deep Anterior Lamellar Keratoplasty (DALK) for stromal corneal opacities

Mathur, Vijay; Parihar, Jitendra Kumar Singh; Srivastava, VK; Avasthi, Ankur

doi:10.1016/j.mjafi.2012.04.023

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Deep anterior lamellar keratoplasty (DALK) has the advantage of no endothelial rejection because it maintains the recipient corneal endothelium. This leads to less need for long term use of topical steroids with lower incidence of related complications such as glaucoma and infection [ 10 – 13 ]. Another advantage of DALK over PKP is that it maintains better globe integrity, thus leaving the eyes less susceptible to trauma [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome

Goweida

Helaly

Ghaith

2015

Journal of Ophthalmology

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Purpose. The study aimed at evaluating the patients' characteristics, risk factors, complications, and visual outcome of traumatic wound dehiscence after keratoplasty. Patients and Methods. A retrospective case series that included 20 eyes of 20 patients who had undergone a previous keratoplasty procedure followed by traumatic wound dehiscence. Records of the selected patients were reviewed. The mean duration of follow-up after repair was 21 months. Included patients were recalled for the final follow-up visit. Results. The procedure of corneal transplantation was penetrating (PKP) in 16 eyes and deep anterior lamellar keratoplasty (DALK) in 4 eyes. The associated anterior segment injuries included iris prolapse in 17 eyes and lens extrusion in 12 eyes. The associated posterior segment injuries included vitreous hemorrhage in 11 eyes and retinal detachment in 4 eyes. The final BSCVA was 0.1 or better in 5 cases (25 %) and was better than hand motions (HM) to less than 0.1 in 7 cases (35 %). Conclusion. Traumatic wound dehiscence following keratoplasty results in poor visual outcome. Cases following DALK may have less wound extent and better final visual outcome. The dehiscence seems most likely to occur during the first year.

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Section: Introductionmentioning

confidence: 99%

Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome

Goweida

Helaly

Ghaith

2015

Journal of Ophthalmology

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“…[6,11,21,22] Moreover, in a long-term comparative study, the recurrence episodes were more severe and complicated in the PK group when compared with the DALK group. [23] Therefore, PK is commonly recommended in severe and progressive infections which are nonresponsive to medications, risking corneal perforation or scleral extension.…”

Section: Discussionmentioning

confidence: 99%

“…[23] Therefore, PK is commonly recommended in severe and progressive infections which are nonresponsive to medications, risking corneal perforation or scleral extension. [11,24] …”

Section: Discussionmentioning

confidence: 99%

“…[7–9] Compared to penetrating keratoplasty (PK), which replaces the whole layer of the cornea, DALK has the benefits of avoiding the complications which go along with “open sky” surgery, less postoperative management, and a low risk of allograft rejection, relieve the lack of donor corneas in developing countries, and is effective in eliminating infection especially in with infections limited to the anterior or mid stroma. [10,11] This study aimed to evaluate the outcomes of DALK in cases of refractory HSK.…”

Section: Introductionmentioning

confidence: 99%

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Clinical evaluation of deep anterior lamellar keratoplasty using glycerol-cryopreserved corneal tissues for refractory herpetic stromal keratitis

et al. 2016

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The study aimed to evaluate the therapeutic effects of deep anterior lamellar keratoplasty (DALK) using glycerol-cryopreserved corneal tissues (GCCTs) in patients with refractive herpes simplex keratitis (HSK). This article was a retrospective, noncomparative, and interventional case series. Patients with HSK underwent DALK using GCCTs at Shanghai Tongji Hospital from 2012 to 2015. The best spectacle corrected visual acuity, recurrent inflammation, graft status, postoperative central graft thickness, and pre/postoperative complications were detected. The follow-up ranged from 24.4 ± 5.6 months (range: 16–38 months). Overall, the best spectacle corrected visual acuity was increased from HM/10 cm to 0.15 before surgery to 0.41 ± 0.14 (range: 0.1–0.8; P < 0.05) at 12 months postoperatively. Intraoperative microperforation occurred in 4 eyes (14.81%), and rejection episodes were encountered in 3 of 27 eyes (11.1%), and all of the eyes reversed. HSK recurred in 2 eyes (7.41%), 1 eye with repeated recurring HSK, and eventually led to perpetual corneal opacity and the patient refused a retransplantation. The mean entire corneal thickness was 0.519 ± 0.018 mm (range: 0.5–0.56 mm) and the mean graft thickness was 0.405 ± 0.033 mm (range: 0.35–0.47 mm) in the final follow-up. The DALK using GCCTs was proven to be an effective and safe therapy in treating refractory HSK.

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“…Deep anterior lamellar keratoplasty (DALK) which was recently introduced as an alternative treatment to provide better visual outcomes, is associated with lesser incidence of post-operative complications [6,7]. This procedure allows total stromal replacement of the recipient's cornea, leaving an intact recipient Descemet membrane and endothelium, to eliminate the risk of corneal donor rejection [8,9]. Deep anterior lamellar keratoplasty has abolished the risk for endothelial immune reactions in the avascular recipient bed to a great extent [10].…”

Section: Introductionmentioning

confidence: 99%

Deep Anterior Lamellar Keratoplasty as an Alternative Treatment on Granular Corneal Dystrophy

Martha¹,

Harmani²,

Shidik³

et al. 2015

JCR

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Introduction: Granular corneal dystrophies (GCD) is an autosomal dominant corneal disorder with bilateral visual disturbances. Deep anterior lamellar keratoplasty (DALK) was recently introduced as an alternative to keratoplasty. This case report mentions DALK as treatment modality for management of young patient with GCD. Case Report: A 24-year old Indonesian man presented with bilateral progressive visual loss since he was fifteen years of age. His bilateral best visual acuity was half meter finger counting. Slit lamp examination on both eyes revealed diffuse hazy corneas with bilateral opacities and multiple granular Bowman's plane and anterior half of stroma. The patient was diagnosed as having a granular corneal dystrophy of both eyes and DALK was performed with manual lamellar dissection technique on his right cornea. The same size of donor cornea was triphaned 1/2 depth and put on top of host bare cornea, then nylon 10-0 was sutured. Two week after procedure, best corrected visual acuity in right eye improved to 6/40. Conclusion: DALK is an alternative procedure for management of patients with GCD whose corneal endothelium is not compromised.

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Clinical evaluation of Deep Anterior Lamellar Keratoplasty (DALK) for stromal corneal opacities

Abstract: DALK is a promising new technique for management of superficial corneal stromal scars using poor quality donor corneal tissue. Initial results are encouraging with minimal complications.

Cited by 8 publications

References 16 publications

Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome

Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome

Clinical evaluation of deep anterior lamellar keratoplasty using glycerol-cryopreserved corneal tissues for refractory herpetic stromal keratitis

Deep Anterior Lamellar Keratoplasty as an Alternative Treatment on Granular Corneal Dystrophy

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