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Cornea:
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Deep Lamellar Keratoplasty Versus Penetrating Keratoplasty for Corneal Lesions.

Panda, Anita M.D.; Bageshwar, Lalit Mohan Singh M.B.A.; Ray, Manotosh M.D.; Singh, J. P. B.Sc.(H), Ophth. Tech.; Kumar, Abhiyan

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Abstract

Purpose: To compare the effectiveness of deep lamellar keratoplasty (DLK) with that of penetrating keratoplasty (PKP) in cases of corneal lesions not involving the endothelium.

Methods: Forty-eight eyes with leukomatous corneal opacity (n = 33), keratoconus with apical scarring (n = 6), granular corneal dystrophy (n = 5), lattice corneal dystrophy (n = 2), and multiple corneal foreign bodies (n = 2) in an age group varying from 16 to 53 years underwent DLK (n = 24) and PKP (n = 24) by utilizing B and (B+ and A) grade M-K preserved donor tissue, respectively. The patients were followed up closely, and the graft clarity, visual achievement, astigmatism and endothelial cell count were evaluated at repeated occasions up to 1 year.

Results: Astigmatism of <3 diopters (D) and greater than equal to5D was obtained in 19 eyes and one eye, respectively, after DLK at 6 months, whereas six eyes of the PKP group had astigmatism <3D, and 12 eyes had greater than equal to5D at the end of 6 months. The same at 1 year was observed in 20 and one eye in the DLK and eight and five eyes of the PKP group. Astigmatism of greater than equal to5D at the end of 6 months in both the groups showed highly significant changes (p < 0.001). Best corrected visual acuity of 6/18 or more was achieved in 18 and 12 eyes at 6 months after DLK and PKP, respectively, which were statistically highly significant (p < 0.001), whereas at 1 year, it was seen in 17 and 15 eyes of the DLK and PKP groups, respectively, which was nonsignificant. The mean endothelial cell count was 2,233.3 +/- 64.453 cells/mm2 and 2,219.6 +/- 102.48 cells/mm2 at 6 months and 1 year, respectively, after DLK, which was nonsignificant. The mean cell count of the donor eyes used for PKP was 2,191 +/- 52.164 cells/mm2, 1,902.8 +/- 70.346 cells/mm2 at 6 months, and 1,579.0 +/- 80.24 cells/mm2 at 1 year. All the values showed highly significant changes (p < 0.001). Further, the graft clarity of greater than equal to3+ was achieved in 20 and 18 eyes at 6 months postoperatively in the DLK and PKP groups, whereas the same was observed in 19 and 13 eyes of both the groups, respectively, at 1-year follow-up.

Conclusion: DLK is a promising procedure and should be practiced more frequently for corneal pathology not involving the endothelium.

(C) 1999 Lippincott Williams & Wilkins, Inc.

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