Abstract
Aim: To report and analyse the incidence of stromal rejction, which is a central island of flattening of the graft associated with thinning in patients who underwent DALK for keratoconus. Materials & Methods: Retrospective review of patients who underwent DALK for progressive keratoconus from 2010 to 2013 was done. Patients who completed 2 years of follow up were included. Slit lamp findings, corneal topography and central corneal thickness were analysed.122 eyes of 71 patients were analysed. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were analysed in each visit Results: Thirty one eyes of thirty one patients showed topographic evidence of Central Island of flattening which correlated with slit lamp finding of stromal haze of varying density. The pachymetry reading of the central cornea varied from 400 to 479µ and correlated with topographic finding of flattening. The average onset of central stromal haze was at 9 months post DALK. None of the patients had bilateral involvement. The central haze progressed over time and was associated with thinning of the cornea. The onset and progression of central flattening was associated with corresponding decrease in UCVA and BCVA. No epithelial defect was noted. Conclusion: 25.4% of keratoconus patients who underwent DALK developed a central island of flattening with associated decrease in the visual acuity. The central haze, flattening and thinning may be a chronic stromal rejection or progressive thinning of cornea associated with disease process of keratoconus.
Highlights
The average onset of central stromal haze was at 9 months post Deep Anterior Lamellar Keratoplasty (DALK)
The onset and progression of central flattening was associated with corresponding decrease in Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA)
Keratoconus is a degenerative, non-inflammatory corneal disorder characterized by progressive stromal thinning and ectasia.10-20% of keratoconus patients requires surgical intervention in advanced stage in the form of either Penetrating Keratoplasty (PK) or Deep Anterior Lamellar Keratoplasty [1]
Summary
Keratoconus is a degenerative, non-inflammatory corneal disorder characterized by progressive stromal thinning and ectasia.10-20% of keratoconus patients requires surgical intervention in advanced stage in the form of either Penetrating Keratoplasty (PK) or Deep Anterior Lamellar Keratoplasty [1]. Deep Anterior Lamellar Keratoplasty (DALK) is preferred over PK due to less incidence of graft failure [2]. Visual outcome of DALK surgery is comparable to PK, avoiding risk of endothelial rejection. Watson et al [4] compared DALK with PK. Compared to PK, one of the major advantages of DALK is normal endothelial cell counts postoperatively. DALK has endothelial cell loss of 1.2% at 2 years. In spite of refractive stability obtained during the first years after PK for keratoconus, increasing astigmatism thereafter suggests that there is a progression of the disease in the host cornea [6]. N Patel has reported the first case of recurrent ectasia in a relatively new treatment option-deep lamellar keratoplasty for keratoconus [9]. We in our study have analysed post DALK patients for any such changes after two year of follow up
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