Comparative Evaluation Of Deep Anterior Lamellar Keratoplasty And Penetrating Keratoplasty For The Treatment Of Macular Corneal Dystrophy
Published 2023 - 41st Congress of the ESCRS
Reference: PP08.05 | Type: Free paper | DOI: 10.82333/tc1k-hg87
Authors: Samar A. Al-Swailem* 1 , Ahmed AlAraj 2 , Ahmad AlAmeer 3
1Anterior segment, Medical Executive Department,King Khaled Eye Specialist Hospital,Riyadh,Saudi Arabia, 2Department of ophthalmology,Qassim University,Buraydah,Saudi Arabia, 3Department of ophthalmology,King Abdullah bin Abdulaziz University Hospital,Riyadh,Saudi Arabia
Purpose
To compare the postoperative outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for macular corneal dystrophy (MCD).
Setting
A Single-center, retrospective, interventional case series.
Methods
A chart review was performed of 100 patients (157 eyes) who underwent primary DALK (DALK group) and PKP (PKP group) for histopathologically confirmed MCD for whom at least 12 months of follow-up was available. There were 22 eyes in the DALK group and 135 in the PKP group. Between-group comparisons were performed of best-corrected visual acuity (BCVA), graft survival, and postoperative complications.
Results
The mean postoperative follow-up was 7.2 ± 6.20 years for the DALK group and 9.7 ± 4.1 years for the PKP group. Postoperative BCVA of 20/40 or better was achieved in 90.9% of the DALK group and 76.3% of the PKP group (P=0.12). At last visit, graft survival was 95.5% (21 eyes) and 91.1% (123 eyes) in DALK and PKP groups, respectively (P=0.69, log-rank test). Corneal graft rejection episodes occurred in 1 (4.5%) DALK graft and 19 (14.1%) PKP grafts. Microbial keratitis and cataract occurred in 6 (4.5%) and 15 (11.1%) PKP eyes. One (4.5%) eye in the DALK group had cataract and none of the DALK cases developed microbial keratitis. Clinically significant recurrence was observed in 4 (2.9%) PKP eyes and 1 (4.5%) DALK eye (P=0.69), respectively
Conclusions
DALK is a viable option for MCD without Descemet membrane involvement. DALK had comparable medium-term visual and survival outcomes to PKP. DALK has the advantage of lower open sky intraoperative complications and lower graft rejection episodes.