Comparison of complications and visual outcomes between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for fungal keratitis.

Abstract

To compare the postoperative complications and visual outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PK) for fungal keratitis (FK). This retrospective study included 94 cases of BB-DALK for FK and 161 cases of PK for FK from a tertiary ophthalmology care centre. The most common FK pathogens were Fusarium (n= 84, 32.9%) and Aspergillus (n= 67, 26.3%). The recurrence rates after BB-DALK and PK were 3.2 and 5%, respectively (p= 0.723). The follow-up duration was 31.9± 15.8months in the BB-DALK group and 33.9± 15.0months in the PK group. The immune rejection rate was significantly lower in the BB-DALK group than in the PK group (1.1 vs. 18.6%, p< 0.001), as was the incidence of secondary glaucoma (p= 0.018). Endothelial cell density in the BB-DALK group tended to be stable at postoperative month 6, whereas the PK group still attenuated at a hyper-physiological rate. Postoperative best-corrected visual acuity (BCVA) significantly improved in both groups (p< 0.001). No significant difference between-group was observed in BCVA, refractive cylinder, and spherical equivalent postoperatively. Big-bubble DALK is a useful and safe alternative to PK for medically uncontrolled FK.