COMPARATIVE ANALYSIS OF CLINICAL AND FUNCTIONAL OUTCOMES OF DEEP ANTERIOR LAMELLAR KERATOPLASTY AND PENETRATING KERATOPLASTY FOR KERATOCONUS PATIENTS

• Main Authors: B. E. Malyugin, S. B. Izmailova, E. E. Aiba, I. V. Drozdov, A. N. Pashtaev
• Format: Article
• Language: Russian
• Published: Publishing house "Ophthalmology" 2015-12-01
• Series: Офтальмохирургия
• Subjects: keratoconus; penetrating keratoplasty; lamellar keratoplasty; endothelial cell density; visual acuity; astigmatism
• Online Access: https://www.ophthalmosurgery.ru/jour/article/view/160

Purpose. To evaluate outcomes of surgical treatment of patients with keratocunus using the technique of deep anterior lamellar keratoplasty (DALK) by the aero-viscoseparation of Descemet’s membrane method in a comparative aspect to results of penetrating keratoplasty (PKP).Material and methods. The investigated group included 100 patients (107 eyes) with keratoconus III-IV using the DALK (76 eyes of 70 patients) and the PKP (31 eyes of 30 patients). Preand post-operatively the standard and special diagnostic methods were used (keratotopography, keratopachymetry, anterior segment optical coherence tomography, confocal microscope). The follow-up period was 2 years.Results. Perforation of Descemet’s membrane was a specific intra-operative complication in the main group (10.5%), but converting surgical technique to PKP was required only in 2.6% of cases. Endothelial cell loss 2 years after surgery was 13.6% in the DALK group and 30.8% – in the PKP group (p<0.05). A clear graft retention was observed in 100% of cases in the DALK group and in 93.5% of cases in the PKP group 24 months after surgery and the best corrected visual acuity (BCVA) was 0.74±0.1 (the main group) and 0.56±0.2 (the control group) (p><0.05). Conclusions. The DALK with the aero-viscoseparation of Descemet’s membrane shows better results of visual rehabilitation of patients and a significantly lower alteration of endothelial cell layer, what substantiates its clinical advantages compared to the PKP.><0.05). A clear graft retention was observed in 100% of cases in the DALK group and in 93.5% of cases in the PKP group 24 months after surgery and the best corrected visual acuity (BCVA) was 0.74±0.1 (the main group) and 0.56±0.2 (the control group) (p<0.05).Conclusions. The DALK with the aero-viscoseparation of Descemet’s membrane shows better results of visual rehabilitation of patients and a significantly lower alteration of endothelial cell layer, what substantiates its clinical advantages compared to the PKP.