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Deep Anterior Lamellar Keratoplasty in Herpes Simplex Corneal Opacities

Sarnicola, Vincenzo MD; Toro, Patricia MD

doi: 10.1097/ICO.0b013e3181a317d3
Clinical Science

Purpose: To report our experience with deep anterior lamellar keratoplasty (DALK) for the treatment of corneal opacities following herpetic keratitis.

Methods: A total of 52 eyes of 52 patients with postherpetic stromal scars with intact endothelium were treated in our department with DALK between 2002 and 2006 as a surgical approach to restore corneal transparency. The main outcome measures of the study were the ability to successfully expose DM (descemetic DALK, dDALK), the number of cases with predescemetic plane achieved surgical plane (pdDALK), pre- and postoperative visual acuity, and endothelial cell count. The mean follow-up period was 31 months. Therapeutic protocol, recurrence of herpetic keratitis, and corneal rejection were evaluated.

Results: dDALK was done in 45 of 52 cases (86.5%) and pdDALK was done in 7 of 52 cases (13.5%). Ruptures of Descemet's membrane occurred in 2 of 52 cases (3.8%) in our series. No case was converted to penetrating keratoplasty. Postoperative best-spectacle-corrected visual acuity was 20/20 in 27 of 52 cases (52%) and at least 80% of patients achieved 20/30 at long-term follow-up. Average endothelial cell loss was 205.32 cell/mm2. Therapeutic protocol was conducted with long-term therapy with oral antiviral drugs and topic steroids after DALK. No episode of rejection or recurrence was detected in these patients through their last visit.

Conclusions: DALK is an alternative and safe procedure to restore vision in cases with significant corneal scarring due to recurrent HSV keratitis with healthy endothelium. Pre- and postoperative antiviral prophylaxis is necessary to prevent recurrence.

From the Department of Ophthalmology, Misericordia Hospital, Grosseto, Italy.

Received for publication August 29, 2008; revision received January 19, 2009; accepted January 31, 2009.

Reprints: Vincenzo Sarnicola, MD, Department of Ophthalmology, Misericordia Hospital, Via Mazzini 62, 58100 Grosseto, Italy (e-mail:

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