Five-year Outcomes of Converted Mushroom Keratoplasty from Intended Deep Anterior Lamellar Keratoplasty (DALK) Mandate 9-mm Diameter DALK as the Optimal Approach to Keratoconus

Myerscough, James; Roberts, Harry; Yu, Angeli Christy; Elkadim, Mohamed; Bovone, Cristina; Busin, Massimo

doi:10.1016/j.ajo.2020.07.009

Cited by 22 publications

(27 citation statements)

References 29 publications

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“…46 Because a type 1 bubble is often limited within 7 to 8mm optical zone, we prefer to combine large-diameter keratoplasty with limited stromal clearance within the central 6 mm. 11,20 Several investigators have likewise used limited stromal clearance for femtosecond laser-assisted DALK. 35,47 By respecting the anatomy of the pre-Descemet layer, restricting the deep dissection to the central cornea has been shown to reduce the risk of Descemet membrane perforation and conversion to PK.…”

Section: Optimizing Visual Outcomesmentioning

confidence: 99%

“…A mushroom-shaped wound configuration for PK whether obtained through microkeratome-assisted or femtosecond laser-assisted techniques can be considered to combine the advantages of a large anterior refractive surface with minimal endothelial transplantation. 11,20,40…”

Section: Minimizing Intraoperative Complicationsmentioning

confidence: 99%

“…Nevertheless, empiric evidence from large interventional case series has thus far validated the clinical benefits of DALK. [9][10][11] From a refractive standpoint, the use of large-diameter grafts for DALK has been shown to provide superior visual outcomes with lower degrees of myopia and astigmatism. 11,45 In a large series of 346 eyes, 9-mm DALK is associated with excellent outcomes with 94% of cases achieving Snellen vision $20/40 and up to 89% with refractive astigmatism ,4.5 diopters.…”

Section: Optimizing Visual Outcomesmentioning

confidence: 99%

“…[9][10][11] From a refractive standpoint, the use of large-diameter grafts for DALK has been shown to provide superior visual outcomes with lower degrees of myopia and astigmatism. 11,45 In a large series of 346 eyes, 9-mm DALK is associated with excellent outcomes with 94% of cases achieving Snellen vision $20/40 and up to 89% with refractive astigmatism ,4.5 diopters. 11 Unlike PK, large-diameter DALK does not pose an increased risk of immune-mediated stromal rejection, which in any case can be managed medically.…”

Section: Optimizing Visual Outcomesmentioning

confidence: 99%

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Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions

Spena

Pellegrini

et al. 2021

Cornea

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Deep anterior lamellar keratoplasty (DALK) involves selective replacement of diseased corneal stroma while preserving normal healthy endothelium. Despite several well-recognized advantages, the uptake of DALK has remained sluggish with an adoption rate that has plateaued over the past decade. Misconceptions such as the rarity of complications of penetrating keratoplasty, lack of standardization of the DALK technique, and limited substantial benefit in visual and refractive outcomes are frequently cited as arguments against performing DALK. This brief review discusses the recent findings that refute these perceived barriers; describes contemporary techniques, tools, and modifications in the surgical approach; and evaluates the evidence regarding the clinical outcomes of DALK.

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Section: Optimizing Visual Outcomesmentioning

confidence: 99%

Section: Minimizing Intraoperative Complicationsmentioning

confidence: 99%

Section: Optimizing Visual Outcomesmentioning

confidence: 99%

Section: Optimizing Visual Outcomesmentioning

confidence: 99%

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Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions

Spena

Pellegrini

et al. 2021

Cornea

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“…Further research is needed to improve the results of IOL power selection following DALK. Finally, since this study specifically evaluated the accuracy of IOL formulas following 9 mm DALK using our standard technique, 10,35,36 our results may not be generalised to patients who had previously undergone DALK using other techniques.…”

Section: Characteristic Valuementioning

confidence: 99%

Accuracy of intraocular lens power calculation for cataract surgery after deep anterior lamellar keratoplasty

Pellegrini

Furiosi

Salgari

et al. 2021

Clinical Exper Ophthalmology

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Background: The purpose of this study was to assess the accuracy of intraocular lens power (IOL) formulas for cataract surgery after deep anterior lamellar keratoplasty (DALK). Methods: This retrospective study included eyes which had previously undergone DALK and underwent standard phacoemulsification with monofocal IOL implantation between January 2012 and January 2021 at Ospedali Privati Forlì "Villa Igea" (Forlì, Italy). The predicted spherical equivalent (SE) was calculated using the Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hoffer Q, Hoffer QST, Holladay 1, Holladay II, Kane and SRK/T formulas. Prediction error (PE) was calculated as the actual postoperative SE refraction minus the SE predicted refraction. Results: Eighty-two eyes of 82 patients were included. The mean PE was negative using all formulas. Friedman test revealed a statistically significant difference of the median absolute PE (MedAE) among the different IOL formulas (P = 0.005). On the basis of the MedAE, the formulas were ranked as follows: SRK/T (0.805 D), Kane (0.810 D), EVO (0.845 D), Hoffer QST (0.847 D), Barrett (0.895 D), Holladay 1 (0.915 D), Haigis (1.010 D) and Hoffer Q (1.070 D) formulas. Conclusions: All formulas had a tendency towards a myopic refractive shift in post-DALK eyes. Although the SRK/T, Kane, EVO and Hoffer QST formulas were more accurate, predictability of refractive outcomes was lower than in virgin eyes.

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Deep Anterior Lamellar Keratoplasty: How to Avoid Conversion to Penetrating Keratoplasty

Forseto

Sampaio

2022

Keratoconus

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Five-year Outcomes of Converted Mushroom Keratoplasty from Intended Deep Anterior Lamellar Keratoplasty (DALK) Mandate 9-mm Diameter DALK as the Optimal Approach to Keratoconus

Cited by 22 publications

References 29 publications

Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions

Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions

Accuracy of intraocular lens power calculation for cataract surgery after deep anterior lamellar keratoplasty

Deep Anterior Lamellar Keratoplasty: How to Avoid Conversion to Penetrating Keratoplasty

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