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Long-Term Graft Survival in Deep Anterior Lamellar Keratoplasty

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

doi: 10.1097/ICO.0b013e31823d0412
Clinical Science

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.

*Department of Ophthalmology, Misericordia Hospital, Grosseto, Italy

DiMSAT, Università di Cassino, Cassino, Italy

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

The authors state that they have no proprietary interest in the products named in this article.

Received January 25, 2011

Accepted August 24, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.