Institutional members access full text with Ovid®

Share this article on:

A Retrospective Contralateral Study Comparing Deep Anterior Lamellar Keratoplasty With Penetrating Keratoplasty

Kim, Myung Hun MD; Chung, Tae-Young MD, PhD; Chung, Eui-Sang MD, PhD

doi: 10.1097/ICO.0b013e318254be4e
Clinical Science

Purpose: This study was conducted to compare endothelial cell (EC) loss, visual outcomes, and complications after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in the contralateral eyes of the same patients.

Methods: A retrospective cohort study was undertaken at the Samsung Medical Center, Seoul Korea. We reviewed the records of 8 patients (16 eyes) who underwent PK in one eye and DALK in the contralateral eye. The DALK procedures were performed according to the Anwar and Teichmann big-bubble technique. EC loss, visual acuity, refractive status, and complications were evaluated to compare these techniques.

Results: EC density was significantly higher after DALK compared with PK (at 12 months: 2045.8 ± 664.8 vs. 1732.6 ± 793.2, P = 0.044; at 24 months: 1900.3 ± 352.2 vs. 1416.2 ± 456.1, P = 0.013). The mean postoperative refractive astigmatism was −3.46 ± 2.57 diopters in the DALK-operated eyes versus −3.38 ± 2.48 diopters in the PK-operated eyes (P = 0.780), and the mean postoperative best-corrected visual acuity was 0.14 and 0.13 logarithm of the minimum angle of resolution, respectively (P = 0.870). There were no significant differences in the uncorrected visual acuity, best-corrected visual acuity, and refractive error between the DALK-operated and PK-operated eyes throughout the follow-up period. Rejection episodes were reported in 2 PK-operated eyes. No graft failures occurred.

Conclusions: Over the 2-year follow-up after DALK, EC loss was significantly lower, whereas the visual outcomes were comparable with those of the PK-operated eyes. No endothelial rejection occurred in the DALK-operated eyes. DALK is an effective alternative surgical procedure for corneal stromal pathologies.

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Reprints: Eui-Sang Chung, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea (e-mail:

The authors state that they have no financial or conflicts of interest to disclose.

Received November 24, 2011

Accepted March 4, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.