scholarly journals Effect of ocular aberration on visual acuity and contrast sensitivity after penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and Descemet's stripping automated endothelial keratoplasty (DSAEK)

2010 ◽  
Vol 10 (15) ◽  
pp. 76-76
Author(s):  
S. M. Pantanelli ◽  
R. Sabesan ◽  
X. Cai ◽  
S. Ching ◽  
G. Yoon ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Penetrating Keratoplasty ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Keratoplasty ◽  
Anterior Lamellar Keratoplasty

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in the treatment of stromal corneal dystrophies

2021 ◽  
Vol 2 (2) ◽  
pp. 116-122
Author(s):  
Ahmed Reda ◽  
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Visual Outcome ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Safety Outcomes

AIM: To compare the efficacy and safety of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in the treatment of stromal corneal dystrophy. METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity [best-corrected visual acuity (BCVA) (LogMAR)] and corneal endothelial cell count (ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference (WMD) and risk ratios (RRs), respectively, along with their respective 95% confidence intervals (CIs). RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71% males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively (WMD=401.62 cell/mm2, 95%CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower (RR=0.30, 95%CI: 0.14-0.64, P=0.002; RR=0.09, 95%CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet’s membrane perforations and postoperative double anterior chamber (All P<0.001). CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

Corneal transplantation trends in France from 2004 to 2015: A 12-year review

2018 ◽  
Vol 28 (5) ◽  
pp. 535-540 ◽  
Author(s):  
Guillaume Bigan ◽  
Marc Puyraveau ◽  
Maher Saleh ◽  
Philippe Gain ◽  
Isabelle Martinache ◽  
...  
Keyword(s):  
Penetrating Keratoplasty ◽  
Corneal Transplantation ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Keratoplasty ◽  
Surgical Indications ◽  
Anterior Lamellar Keratoplasty ◽  
Important Shift

Purpose: The aim of this study was to report the 12-year longitudinal trends in indication and corneal transplantation techniques in France from 2004 to 2015. Results: The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed. The patient indications and types of transplant performed were analyzed. A total of 46,658 corneal transplantations were performed between 2004 and 2015, with 34,187 (73.3%) penetrating keratoplasty and 10,452 (22.4%) lamellar keratoplasty. The leading surgical indications were secondary endothelial failure (24.3%), keratoconus (18.8%), regraft (13.5%), and Fuchs endothelial corneal dystrophy (15.1%). Endothelial keratoplasty became the preferred technique for endothelial diseases and deep anterior lamellar keratoplasty the preferred technique for keratoconus, surpassing penetrating keratoplasty in 2013. Conclusion: Secondary endothelial failure is the top indication for performing a keratoplasty over the 12-year period. There was a shift from penetrating keratoplasty to endothelial keratoplasty performed for Fuchs endothelial corneal dystrophy and secondary endothelial failure, and to deep anterior lamellar keratoplasty, performed for keratoconus. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.

scholarly journals Contrast sensitivity in deep anterior lamellar keratoplasty versus penetrating keratoplasty

Clinics ◽  
2007 ◽  
Vol 62 (6) ◽  
Author(s):  
Carlos Anchieta Castro Cardoso da Silva ◽  
Ederson Schweitzer de Oliveira ◽  
Manoel Paulo Souza de Sena Júnior ◽  
Luciene Barbosa de Sousa
Keyword(s):  
Contrast Sensitivity ◽  
Penetrating Keratoplasty ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty

scholarly journals Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Vincent M. Borderie ◽  
Sara Touhami ◽  
Cristina Georgeon ◽  
Otman Sandali
Keyword(s):  
Visual Acuity ◽  
Predictive Factors ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
First Choice ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble

Objective. Big bubble (BB)-deep anterior lamellar keratoplasty (DALK) has become the reference transplantation technique for corneal stromal disorders. Type 1 BB is the desired aspect but it is not constant. We aimed to determine the predictive factors of type 1 BB success. Methods. Observational cohort study including 77 consecutive eyes of 77 patients undergoing DALK by one surgeon at a single reference center without any selection. Clinical and spectral domain optical coherence tomography data were collected pre- and postoperatively. Results. Stromal scars were found in 91.8% of cases and were located in the anterior (90.9%), mid (67.5%), and posterior (36.4%) stroma. Type 1 BB (49.3% of cases) was significantly associated with the absence of scars in the posterior stroma, stage 1–3 keratoconus, and deep trephination. Among eyes with posterior scars, type 1 BB was associated with higher minimal corneal thickness, maximum-minimum corneal thickness < 220 μm, and diagnosis other than keratoconus. Eyes with type 1 BB featured significantly thinner residual stromal bed (22 ± 8 µm versus 61 ± 28 µm), thinner corneas at 12, 24, and 36 months, and better visual acuity at 12 months compared with eyes with no type 1 BB. Conversely, no significant differences between both groups were observed for graft survival, visual acuity at 24 and 36 months, and endothelial cell density at 12 and 36 months. Conclusion. OCT assessment before DALK is useful for choosing trephination depth that should be as deep as possible and for looking for posterior scars. The BB technique may not be the most appropriate method in keratoconus with posterior scars. Follow-up data do not support the need for conversion to penetrating keratoplasty when type 1 BB cannot be obtained nor does it support the need for performing a penetrating keratoplasty as a first-choice procedure in eyes with posterior stromal scars.

scholarly journals Interface infectious keratitis after anterior and posterior lamellar keratoplasty. Clinical features and treatment strategies. A review

2018 ◽  
Vol 103 (3) ◽  
pp. 307-314 ◽  
Author(s):  
Luigi Fontana ◽  
Antonio Moramarco ◽  
Erika Mandarà ◽  
Giuseppe Russello ◽  
Alfonso Iovieno
Keyword(s):  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Virtual Space ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Infectious Keratitis ◽  
Endothelial Keratoplasty ◽  
Corneal Infection ◽  
Anterior Lamellar Keratoplasty ◽  
Sight Loss

Interface infectious keratitis (IIK) is a novel corneal infection that may develop after any type of lamellar keratoplasty. Onset of infection occurs in the virtual space between the graft and the host where it may remain localised until spreading with possible risk of endophthalmitis. A literature review identified 42 cases of IIK. Thirty-one of them occurred after endothelial keratoplasty and 12 after deep anterior lamellar keratoplasty. Fungi in the form of Candida species were the most common microorganisms involved, with donor to host transmission of infection documented in the majority of cases. Donor rim cultures were useful to address the infectious microorganisms within few days after surgery. Due to the sequestered site of infection, medical treatment, using both topical and systemic antimicrobials drugs, was ineffective on halting the progression of the infection. Injection of antifungals, right at the graft–host interface, was reported successful in some cases. Spreading of the infection with development of endophthalmitis occurred in five cases after Descemet stripping automated endothelial keratoplasty with severe sight loss in three cases. Early excisional penetrating keratoplasty showed to be the treatment with the highest therapeutic efficacy, lowest rate of complications and greater visual outcomes.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in corneas showing a high or low graft rejection risk

2018 ◽  
Vol 29 (3) ◽  
pp. 295-303
Author(s):  
Edgar Javier Infantes Molina ◽  
Javier Celis Sánchez ◽  
José Maria Tenias Burilllo ◽  
David Diaz Valle ◽  
José Manuel Benítez-Del-Castillo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
High Risk ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Low Risk ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity

Purpose: To compare visual, topographic and topometric outcomes in patients subjected to deep anterior lamellar keratoplasty or penetrating keratoplasty showing a high or low risk of graft rejection. Setting: Complejo Hospitalario La Mancha Centro, Ciudad Real, Spain. Materials and methods: Data were reviewed for consecutive patients with a corneal stroma disease undergoing deep anterior lamellar keratoplasty or penetrating keratoplasty over the period 2009–2015 at our centre by the same surgeon. The outcome measures examined were 2-year follow-up best-corrected visual acuity, refractive error, topographic astigmatism, intraocular pressure, endothelial cell density and central corneal thickness. Results: Of 115 eyes enrolled, 46 underwent deep anterior lamellar keratoplasty (15 low risk, 31 high risk) and 69 penetrating keratoplasty (23 low risk, 46 high risk). Mean postoperative best-corrected visual acuity (logMAR) in the low- and high-risk groups, respectively, were 0.31 and 0.26 for deep anterior lamellar keratoplasty (p = 0.32) and 0.40 and 0.51 for penetrating keratoplasty (p = 0.28). The values for the high-risk deep anterior lamellar keratoplasty versus high-risk penetrating keratoplasty patients were 0.26 and 0.51, respectively (p = 0.004). Mean postoperative spherical equivalents were −2.60 D for low-risk deep anterior lamellar keratoplasty versus −2.29 D for high-risk deep anterior lamellar keratoplasty (p = 0.19), and −0.41 D for low-risk penetrating keratoplasty versus −0.13 D for high-risk penetrating keratoplasty (p = 0.51). Conclusion: Final best-corrected visual acuity and visual acuity gains were better for deep anterior lamellar keratoplasty, mainly in corneas with a high rejection risk. Despite a better corneal thickness recorded in the deep anterior lamellar keratoplasty group, the other variables examined were comparable. Deep anterior lamellar keratoplasty emerged as an effective alternative to penetrating keratoplasty for patients with a disease affecting the corneal stroma.

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