Skip Navigation LinksHome > June 2012 - Volume 31 - Issue 6 > Long-Term Graft Survival in Deep Anterior Lamellar Keratopla...
doi: 10.1097/ICO.0b013e31823d0412
Clinical Science

Long-Term Graft Survival in Deep Anterior Lamellar Keratoplasty

Sarnicola, Vincenzo MD*; Toro, Patricia MD*; Sarnicola, Caterina; Sarnicola, Enrica; Ruggiero, Andrew PhD

Collapse Box


Purpose: To determine corneal graft survival rates up to 10 years in a large consecutive series of deep anterior lamellar keratoplasties (DALKs).

Methods: A retrospective, consecutive, noncomparative cases series of DALK procedures in a total of 806 eyes of 711 patients with stromal diseases and healthy endothelium performed between 2000 and 2009. Inclusion criterion was surgery performed by a single surgeon (660 eyes), with at least 6 months of follow-up. Graft survival was analyzed using the Kaplan–Meier method. Endothelial loss was analyzed with the Gaussian distribution and the χ2 methods. Follow-up time, and preoperative and postoperative endothelial cell density (ECD) were considered in the analyses.

Results: Six hundred sixty eyes of 502 patients met the entry criteria. Mean length of follow-up was 4.5 years (range, 0.5–10 years). We report an average graft survival rate of 99.3% (range, 98.5%–100%); 3 eyes (0.45%) experienced graft failure and 1 eye (0.15%) developed late endothelial failure because of an intraoperative complication. Predominant indications for DALK in this series were keratoconus (74%), postherpetic keratitis scarring (15%), and corneal stromal opacities of different etiology (11%). Endothelial loss from preoperative levels averaged 11% (range, 10%–13%) at 6 months through 10 years after DALK. ECD was unchanged between 6 months postoperatively and the last follow-up visits.

Conclusions: DALK is a successful form of transplantation in stromal corneal disorders with healthy endothelium, with higher long-term graft survival rates and stable ECD 6 months postoperatively. DALK survival rates do not vary significantly over time.

© 2012 Lippincott Williams & Wilkins, Inc.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.