Purpose: To report the indications and long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of visually significant stromal opacities.
Design: Retrospective, interventional, consecutive case series.
Methods: Setting: Private hospital.
Study population: Thirteen eyes that underwent DALK after DSAEK at our institution. Indications for DALK after DSAEK included both stromal opacities persisting after DSAEK and stromal opacities occurring secondarily in post-DSAEK corneas. DALK was always performed in a standardized fashion including exchange of a disc of full-thickness recipient cornea (up to the DSAEK stromal surface),7.0 mm in diameter, with a donor lamella obtained by microkeratome-assisted dissection, punched to 7.0 mm and sutured into place with a double running 10-0 nylon suture.
Main outcome measures: Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density (ECD).
Results: Mean follow-up was 26 ± 18 months (range = 6-60 months). Indications for DSAEK were full-thickness graft failure (n = 8), DSAEK graft failure (n = 3), and pseudophakic bullous keratopathy (n = 2). Indications for subsequent DALK were persisting stromal opacity (n = 9) and stromal opacities newly occurred after DSAEK as a result of HSV keratitis (n = 2) or interface infection (n = 2). After complete suture removal, mean BSCVA was 20/28 (0.14 ± 0.8 logMAR) in eyes without ocular comorbidities affecting visual acuity (n = 7), while refractive astigmatism was within 4 diopter (D) in all but 1 eye (average = 3.2 ± 1.4 D). No intraoperative complications were recorded.
Conclusions: Performing DALK on DSAEK eliminates the need for open-sky surgery, achieving visual results comparable to those of penetrating keratoplasty, while sparing a healthy endothelial graft.
Copyright © 2016 Elsevier Inc. All rights reserved.