Complications in deep anterior lamellar keratoplasty – A retrospective interventional analysis in a large series

Abstract

Purpose: To analyze the complications in patients managed with deep anterior lamellar keratoplasty (DALK) for diseases of the anterior corneal stroma. Methods: This is a retrospective analysis of all the patients who underwent DALK in a tertiary care center in South India from 2010 to 2020. A total of 474 eyes in 373 patients were included in the study. Patients who underwent DALK for advanced keratoconus, keratoconus with Bowman’s membrane scar, healed hydrops, macular corneal opacity, macular corneal dystrophy, granular corneal dystrophy, spheroidal degeneration, pellucid marginal degeneration, post–laser-assisted in situ keratomileusis ectasia, descematocele, post-collagen cross-linking aborted melt and dense scar, and post-radial keratotomy were included in the study. The patients were followed up for 17.2 +/- 9.2 months (1–9 years). Results: Complications noted in the surgery were intra-operatively Descemet’s membrane perforation in 31 eyes (6.54%), post-operatively secondary glaucoma in 16 eyes (3.37%), cataract in seven eyes (1.47%), suture-related complications in five eyes (1.05%), graft rejection in three eyes (0.63%), traumatic dehiscence in two eyes (0.42%), filamentary keratitis in two eyes (0.42%), interface infiltrate in one eye (0.21%), and recurrence of disease in four eyes (7.14%) out of 57 eyes with corneal dystrophy. Conclusion: DALK as an alternative to penetrating keratoplasty for anterior corneal stromal diseases. It has become an automatic choice for diseases of the anterior cornea requiring keratoplasty. Complications can occur at any stage of surgery; however, if identified and managed early, they can result in optimal outcome.

Bubbling With Confidence: A Study of Numerous Deep Anterior Lamellar Keratoplasty Cases Using Anwar’s Big Bubble Technique

“…The study reported a mean preoperative K2 value of 56.1 D and a mean postoperative K2 value of 45.5 D for the DALK group, a mean preoperative K2 value of 56.5 D, and a mean postoperative K2 value of 44.5 D for the PK group [12]. The advantages of DALK are well documented in the literature [13][14][15]. A study by Hakeem in 30 eyes comparing manual versus big bubble DALK found better postoperative BCVA in the big bubble variety [16].…”

Subfoveal choroidal thickness increases after excimer laser-assisted penetrating keratoplasty but not after excimer laser-assisted deep anterior lamellar keratoplasty

“…suprachoroidal hemorrhage (SCH), which appears in 0.1% of the eyes undergoing a PKP 19 , 20 . To the best of our knowledge, none of the major papers on outcomes of DALK reported any SCH 21 – 24 . This fact alone might lead us to consider that DALK affects the uveal track and mainly the choroid less than PKP.…”