Comparison of Techniques Used for Removing the Recipient Stroma in Anterior Lamellar Keratoplasty

Abstract

To compare 3 techniques used for removing the recipient stroma during anterior lamellar keratoplasty (ALK): the "big-bubble" technique, manual dissection using a crescent blade and slitlamp operating microscope, and microkeratome lamellar cut. Design: Retrospective comparative cohort study of 69 consecutive ALKs and 69 consecutive penetrating keratoplasties (PKs). Manifest refraction, slitlamp examination, Goldmann tonometry, ultrasound pachymetry, specular microscopy, and confocal microscopy findings were recorded. Results: The 12-month graft survival estimate was 98.5% in the ALK group and 94.1% in the PK group (P =.19). Higher endothelial cell density was found after ALK (PϽ.001). At 12 months (before suture removal), 53%

Comparative study of keratoconus between Anwar's deep anterior lamellar keratoplasty versus converted penetrating keratoplasty

“…9 There is increased evidence that DALK could be a safer alternative to PK even without demonstrating better visual results 13,14 when executed adequately with deep dissection. 15 Finally, DALK would be more useful for preserving ocular structural integrity in the presence of trauma. 16,17 In addition, some authors have stated that the growing use of the lamellar technique could be beneficial in the long term, with cost savings due to the lower frequency of re-interventions and those related to the management of rejection, postoperative and intraocular complications.…”

How Much Progress Has Been Made in Corneal Transplantation?

“…1,18 The incidence of DM perforation has been reported to be highly variable, ranging from 6% to 57%. 11,13,15,[19][20][21][22][23] The relatively high incidence of DM perforation in our series might result in poorer graft survival than with PKP. The high incidence of DM rupture may be attributable to the involvement of multiple surgeons, including some inexperienced surgeons.…”

Comparative Evaluation of Big-Bubble Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in a Case of Macular Corneal Dystrophy

“…No significant difference, however, in astigmatic outcome between DALK and PK has been reported. 3,7 In a large retrospective case series reporting 229 PKs carried out for macular dystrophy, endothelial rejection episodes occurred in 20% of eyes, resulting in irreversible endothelial failure in 3.5% of eyes. The endothelial rejection accounted for nearly 35% of the failed corneal transplants in this series.…”

“…No cause for the age effect was evident, however. 7 Stromal dystrophies are known to recur within the donor material after corneal transplantation and therefore may require multiple grafts. The recurrence of macular dystrophy in patients who have undergone PK has been reported to be up to 25% in an average follow-up period of 7-22 years.…”