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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.

*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

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.