Transcript Deep Anterior Lamellar Keratoplasty (DALK) Vs Penentrating

Deep Anterior Lamellar Keratoplasty (DALK) Vs
Penetrating Keratoplasty (PK) in patients with
Keratoconus (KC).
Dr. K.S.SIDDHARTHAN
Aravind Eye Hospital
Coimbatore
The author has no financial interest in the subject matter of
this poster.
Introduction
 Deep Anterior Lamellar Keratoplasty [DALK] has been recommended as an
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alternative to Penetrating keratoplasty( PK) for the treatment of
keratoconus.
Corneal graft failure in PK is most frequently the result of destruction of the
donor endothelium by inflammatory cells during acute or chronic allograft
rejection.
Comparative studies with PK have shown overall similar visual outcomes
when both techniques are used .
The main disadvantage of DALK is of being both a technically more
challenging and time consuming procedure with a steep learning curve
compared to PK.
In this study we report the comparison of clinical outcomes of DALK Vs
PK.
Purpose
 To compare the clinical outcomes of Deep Anterior Lamellar
Keratoplasty and Penetrating Keratoplasty in patients with
keratoconus.
Methods
 Prospective & Interventional case series. 66 eyes of 53 consecutive
patients with KC who underwent DALK and PK between
September 2003 to April 2009 were routinely included.
 Visual and refractive outcomes at 1,3,6,12 months were analyzed.
Complication rates were also analyzed.
Data Analysis
Comparison of
 Visual acuity - (Uncorrected and Best corrected) at 1 month
and 1 year – Chi Square test.
 Spherical equivalents - (non- normal distribution - Mann
Whitney U test).
 Complication rates – Compared Between DALK and PK.
RESULTS
Visual Outcome at 1 month
Uncorrected Visual acuity
p-0.639 (NS)
Best corrected Visual acuity
p-0.242 (NS)
Visual Outcome at 1 Year
Uncorrected Visual acuity
p-0.830 (NS)
Best corrected Visual acuity
p-0.862 (NS)
Spherical Equivalent
Complications
 There was no intra operative complication in PK compared to
27.3% in DALK.
 Postoperative graft infection was not statistically significantly
different between the two surgery types (DALK – 5.3% vs PK 9.1%) (p-0.527).
 Post operative graft rejection was seen in one patient with PK.
Complications of DALK
Inter phase Debris
Suture related Graft Melt
Descemet’s Detachment
Graft Infection
Descemet’s Tear
Summary
 Visual improvement in DALK (83% ) was better than PK (63.4%) at 1
month. However, at 1 year the visual improvement between the two
procedures were comparable (92.5% in DALK and 90.9% in PK).
 The average difference made in spherical equivalent at 1 year
compared to preoperative period was 10.5±7.5 in DALK and 19.2±5.2
in PK. The impact on spherical equivalent by PK was statistically
significantly higher (p-0.003).
 Intra operative complications were more in DALK ,compared to PK.
Conclusions
 Penetrating keratoplasty is no longer an automatic choice for
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the surgical treatment for keratoconus.
Best-corrected visual acuity and refractive results are similar
after DALK and PK.
DALK allows earlier visual rehabilitation, use of low dose
steroids for shorter duration and earlier suture removal
compared to PK.
DALK is more technically challenging but allows the risk of
endothelial rejection to be avoided.
DALK is a safe alternative to penetrating keratoplasty in
patients with keratoconus.
Bibliography
 Troutman RC, Lawless MA. Penetrating keratoplasty for
keratoconus. Cornea 1987;6:298 –305.
 Panda A, Bageshwar LM, Ray M, et al. Deep lamellar
keratoplasty versus penetrating keratoplasty for corneal
lesions. Cornea 1999;18:172–5.
 Jun Shimazaki, Shigeto Shimmura et al .Randomized
Clinical Trial of Deep Lamellar Keratoplasty Vs Penetrating
Keratoplasty. Am J Ophthalmol 2002;134:159–165.
 Stephanie L. Watson, FRANZCO et al .Comparison of Deep
Lamellar Keratoplasty and Penetrating Keratoplasty in
Patients with Keratoconus. Ophthalmology
2004;111:1676–1682