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Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) for keratoconus: a systematic review

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Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 16/09/2014 | 08:00-10:30

Paper Time: 08:31

Venue: Boulevard B

First Author: : C.Henein UK

Co Author(s): :    M. Nanavaty              

Abstract Details


To perform a systematic review of randomised and non-randomised comparative studies assessing the outcomes of DALK and PK for keratoconus. Evidence supporting similar outcomes between DALK and PK for the treatment of keratoconus is questionable because the number of randomised trials is sparse and underpowered to detect any meaningful difference. Furthermore, more recent randomised studies and the evolving techniques and expertise in the DALK procedure may bear weight to overall findings.


Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK


A systematic review of English abstracts using MEDLINE (1950-2013),
Embase (1980-2013) and database. Inclusion criteria were sample size of at least 20 eyes in each arm and a follow-up of at least 12 months. Primary outcomes were uncorrected (UCVA) and best-corrected visual acuity (BCVA). Secondary outcomes were allograft rejection, failure, endothelial density and complications. Fixed and random effects models were
applied to results combined for analysis.


Three randomized and 7 non-randomised studies were included. There was no significant difference in UCVA or BCVA (P>0.05). DALK had significantly less allograft rejection and more endothelial density compared to PK (p<0.05). Other secondary outcome measures were not significantly different. There was no evidence to suggest heterogeneity of study results (p>0 .05).


Both randomised and non-randomised studies showed no difference in visual acuity between DALK and PK. DALK reduces the risk of allograft rejection and has significantly increased endothelial cell density at 12 months follow-up.

Financial Interest:


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