Deep Anterior Lamellar Keratoplasty Over Penetrating Keratoplasty for Host Rim Thinning and Ectasia

Abstract

To describe the technique and evaluate the outcomes of patients who had deep anterior lamellar keratoplasty (DALK) for ectasia within or outside the graft-host interface in a previous penetrating keratoplasty (PK). Retrospective review of interventional case series. Seven eyes that underwent DALK for corneal ectasia after previous PK. DALK encompassing the area of ectasia and the previous PK. Uncorrected visual acuity, best spectacle-corrected visual acuity, keratometry and topography, and complications. Seven eyes had DALK, 4 developed Descemet membrane tears, and 2 eyes had deep graft-host dehiscence from the previous PK intraoperatively. At 12 months, mean uncorrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.157 to 0.74. Mean best spectacle-corrected visual acuity improved from 0.82 to 0.37 at 12 months. DALK can be successfully performed over a previous PK. Intraoperative Descemet tears or dehiscence of Descemet at the previous graft-host interface can complicate surgery, but if successfully managed can produce a significant improvement in visual acuity.