Purpose: To examine clinical outcomes in deep anterior lamellar keratoplasty (DALK) for keratoconus using contemporary techniques in a multisurgeon public healthcare setting.
Design: Consecutive, retrospective case series.
Methods: Setting: Moorfields Eye Hospital, London, United Kingdom.
Study population: Consecutive cases of keratoconus treated with non-laser assisted DALK from September 1, 2012, to September 31, 2016.
Observation procedure: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived for analysis.
Main outcome measures: Graft failure rate and percentage of patients with corrected distance visual acuity (CDVA) ≥20/40 within 1 year of surgery and at final review after suture removal.
Results: Three hundred fifty-seven eyes of 338 patients undergoing DALK (91.3% big-bubble technique attempted) were analyzed. A total of 4.2% (95% confidence interval [CI] 2.4%-6.8%) of corneal transplants had failed within the follow-up period (21.8 ± 11.4 months), and 75.9% of eyes had CDVA ≥20/40 within 1 year of surgery, rising to 81% after suture removal. Forty-two primary surgeons (31 trainees) participated. Intraoperative perforation of Descemet membrane occurred in 45.4% of eyes. A total of 24.1% were converted to penetrating keratoplasty (PK) intraoperatively. Conversion to PK increased the risk of transplant rejection (P = .026; odds ratio [OR] 1.94; 95% CI 1.1-3.5) and secondary glaucoma (P = .016; OR 4.0; 95% CI 1.3-12.4). Transplant rejection increased the risk of graft failure both overall (P = .017; OR = 3.9; 95% CI 1.4-11.0) and when cases converted to PK were excluded (P = .028; OR = 3.35; 95% CI 1.1-9.9).
Conclusion: DALK for keratoconus achieves early results similar to those published for PK in a multisurgeon setting. Conservative management of intraoperative Descemet membrane perforation, where possible, may be safer than conversion to PK.
Copyright © 2019 Elsevier Inc. All rights reserved.