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Surgical outcome of layer-by-layer deep anterior lamellar keratoplasty for patients with previous corneal infection/inflammation

Poster Details

First Author: D.Ma TAIWAN

Co Author(s):    J. Chen   C. Hsiao           

Abstract Details


Although the big bubble technique is the standard technique for DALK, it is suitable for non-inflammatory corneal diseases like keratoconus. However, in corneas with previous infection/inflammation, the technique is less successful, and the corneal stroma has to be removed by debulking technique. The purpose of this study is to report the surgical outcome of layer-by-layer DALK in corneas with or without previous infection/inflammation.


Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan


We retrospectively reviewed the medical history of 17 patients (M : F = 10 : 7; mean age 38.4 y/o) who had previously received layer-by-layer DALK for corneal scar due to infection/inflammation (n=10), degeneration (n=4), or keratoconus (n=3). Diameter of trephination ranged from 7.0 - 8.0 mm, and the graft was oversized by 0.25 to 0.5 mm. Starting from 3 months post-op, selective suture removal was performed to reduce corneal astigmatism. Post-operatively, the patients were followed for at least 1 year, and best-corrected vision, sphere and cylinder power, and endothelial cell number were measured.


The mean F/U period was 34.3 +/- 12.6 months. Microperforation was experienced in 2 cases, however, DALK was performed as planned. In 7 cases, gapping of the graft was noted, and bubble temponade was performed. Post-operatively, BCVA remained similar in 3 cases, increase between 1 to 3 lines in 6 cases, increase between 4 to 6 lines in 4 cases, and more than 7 lines increase in 4 cases. The averaged sphere power was -2.5 +/- 6.3 D, average cylinder power -3.5 +/- 2.4 D, and averaged endothelial count was 1888 +/-462 cells/mm2. All grafts remained clear at last F/U.


Compared with previous studies, our cases showed similar post-op endothelial count, myopic shift, and refractive astigmatism. When performed carefully, layer-by-layer DALK may result in similar vision outcome comparable to that achieved using big bubble technique. FINANCIAL DISCLOUSRE: NONE

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