Outcomes in deep anterior lamellar keratoplasty (DALK) for corneal ectasia

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 09:22

Venue: Hall C2

First Author: : E. Hughes IRELAND

Co Author(s): :    J. Stokes   P. Condon   S. Daya              

Abstract Details

Purpose:

Corneal ectasia can be managed with contact lenses in the majority of cases. Progression of disease can be slowed or treated using riboflavin cross linking, and contact lens intolerance may be reduced with insertion of intracorneal ring segments. However, a proportion of patients will eventually require corneal transplantation- either lamellar, or penetrating. This study presents the outcomes of patients who underwent DALK for corneal ectastia.

Setting:

Single ophthalmology practice in Waterford City, Ireland. Patients underwent surgical procedures in East Grinstead, UK.

Methods:

Retrospective review of all patients who underwent DALK between 2006 and 2014 within one practice. Parameters recorded included diagnosis and previous treatment, indication for surgery, pre-operative and post-operative clinical measurements (unaided vision- UAVA, best corrected vision- BCVA, refractive error, and corneal topography), complications and subsequent procedures.

Results:

12 patients were identified, mean age 42 years. 11 patients had keratoconus, and one patient had post-LASIK ectasia. The average length of follow-up was 31 months. Mean pre-operative BCVA was 0.87 (LogMAR), improving to 0.55 (UAVA) and 0.34 (BCVA) post-operatively. Mean k on corneal topography reduced by 9.6D on average from 54.78D to 44D. 4 patients had no subsequent complications. Complications recorded included stromal rejection (2), graft-host interface scar (2), and steroid induced glaucoma (1). 4 patients developed cataract. 3 patients had Femto-assisted astigmatic keratotomy for residual astigmatism after suture removal. The patient with post-LASIK ectasia required penetrating keratoplasty.

Conclusions:

DALK is a suitable surgical option when corneal transplantation is indicated in corneal ectasia, and may be favorable over PK in this relatively young cohort with healthy corneal endothelium. 66% of our patients achieved BCVA of 0.3 or better (Snellen equivalent 6/12). This compares with 78-92% in published case series. However, the potential benefits must be weighed against the possibility of the unfavourable outcomes described.

Financial Disclosure:

NONE