Ten-Year Outcomes Of Large Diameter (9Mm) Deep Anterior Lamellar Keratoplasty (Dalk)
Published 2025 - 43rd Congress of the ESCRS
Reference: FP15.15 | Type: Free paper | DOI: 10.82333/6z4z-4w25
Authors: Nicole Fram 1 , Neda Shamie 2 , Arjan Hura 2 , Li-Chen Pan* 3 , Carine Hsiao 3 , Dana Gummerson 4 , George Wright 4 , Lawrence Woodard 5
1Advanced Vision Care,Los Angeles,United States, 2Maloney-Shamie-Hura Vision Institute,Los Angeles,United States, 3Global HEOR,Alcon,Fort Worth,United States, 4Value and Evidence,EVERSANA,Burlington,Canada, 5Atlanta Eye Surgery Center,Atlanta,United States
Purpose
To report the long-term outcomes of large diameter deep anterior lamellar keratoplasty (DALK).
Setting
Ospedali Privati Forlì "Villa Igea" - Forlì, Italy
Methods
This single-center interventional case series included 643 eyes that underwent 9mm diameter DALK for keratoconus (n=421), infectious keratitis (n=126), corneal dystrophy (n=32), failed ALK (n=19), other stromal disease (n=42), using a modified big bubble technique with stromal clearance limited to a central 6mm optical zone. Best corrected visual acuity, endothelial cell loss and complications were evaluated annually postoperatively with 5-and 10-year follow-up available in 643 and 111 eyes, respectively.
Results
At 5 and 10 years, a Snellen BCVA of ≥ 20/40 was achieved in 96% and 93% of eyes, while BCVA of ≥20/20 was achieved in 41% and 39%, respectively. Mean ECL was 18±6% at 5 years and 24±9% at 10 years. Refractive astigmatism was greater than 4.5D in 36 eyes (5%). The 5- and 10-year cumulative probability for stromal rejection was 2% at 5 years and 3% and for graft survival was 99% and 98%, respectively.
Conclusions
The study provides evidence that 9mm DALK provides visual outcomes superior to those reported for PK with excellent 10-year survival.