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Long-term Outcomes of Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty in Australian Keratoconus Patients

MacIntyre, Ross MD*; Chow, Sing-Pey MBBS*; Chan, Elsie MBBS, FRANZCO*,†; Poon, Alexander MBBS, FRANZCO*

doi: 10.1097/ICO.0b013e3182a9fbfd
Clinical Science

Purpose: The aim of this study is to compare long-term visual and surgical outcomes after performing deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus.

Methods: This is a retrospective review of 73 consecutive patients with keratoconus, managed with DALK or PK, between 2000 and 2010, by a single surgeon. Data were collected on baseline parameters, best-corrected visual acuity (BCVA) in logarithm of the mean angle of resolution (logMAR), subjective refraction, graft survival, and complications.

Results: Thirty-one (42.5%) eyes underwent a DALK, and 42 (57.5%) eyes underwent a PK. All PK-operated and 29 out of 31 (93.5%) DALK-operated eyes remained clear at the last review. Postoperative complications were significantly more frequent after PK (57.1%) than after DALK (26.5%; P = 0.0197). The mean BCVA was not significantly different for DALK (0.14 logMAR, SD 0.2) versus PK (0.05 logMAR, SD 0.11); however, eyes that underwent PK were more likely to achieve a BCVA of 0.0 logMAR (P = 0.0029). Subjective refraction and method of visual correction (spectacles or contact lenses) were similar for each group.

Conclusions: DALK-operated patients in this study showed similar graft survival, fewer postoperative complications, and equivalent refractive outcomes. No significant difference in the mean BCVA was noted between DALK and PK cases.

Author Information

*Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; and

Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.

Reprints: Ross MacIntyre, Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, Victoria 3002, Australia (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received May 19, 2013

Accepted August 23, 2013

© 2014 by Lippincott Williams & Wilkins.