Long‐term Graft Survival and Visual Outcome of Deep Anterior lamellar keratoplasty versus penetrating keratoplasty for keratoconus: A minimum of 10 years follow‐up

Abstract

AbstractPurposeTo compare long‐term visual outcome and graft survival between Deep Anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus (KC), with a minimum of ten years follow‐up.MethodsRetrospective, comparative cohort study of 191 KC eyes who underwent DALK and PK between January 2000 and October 2006, at a largest tertiary eye hospital in the country. Baseline and postoperative outcomes included: best‐corrected visual acuity (BCVA), spherical equivalent (SE), keratometric power, and keratometric astigmatism. Difference in overall effect and effect at each time point were presented. Graft survival was analyzed with use of the Kaplan ‐Meier survival method.Results97 (50.8%) eyes underwent PK and 94 (49.2%) eyes underwent DALK. mean follow‐up in PK & DALK groups were 13.45±2.7 years and 12.18±1.9 years, respectively. Post‐operative Mean BCVA (LogMar) was significantly worse in DALK (0.49 ± 0.26) in comparison to PK (0.40 ± 0.2) at 3 months whereas BCVA was significantly better in DALK (0.23 ± 0.18) in comparison to PK (0.37 ± 0.63) at the last follow‐up. However, the overall effect of BCVA for both groups was insignificant. The overall effect of SE and keratometric power were insignificant. More complications were reported in PK (69%) group versus DALK (31%). At last follow‐up, 15 grafts failed, 9 were PK and 6 were DALK. Graft rejection was the most common reported cause of failure in both groups (PK 73%, DALK 50%). There was no overall significant difference between PK and DALK in time to graft failure (p = 0.59).ConclusionsLong‐term follow‐up of PK and DALK for KC showed similar overall graft survival and no significant difference in mean BCVA overall effect, indicating that both keratoplasties can offer long‐term satisfactory visual outcomes with less rejection and less overall post‐operative complications in DALK.