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Clinical science
Long term visual outcomes, graft survival and complications of deep anterior lamellar keratoplasty in patients with herpes simplex related corneal scarring
  1. Douglas A M Lyall1,
  2. Sonali Tarafdar1,
  3. Michael James Gilhooly2,
  4. Fiona Roberts3,
  5. Kanna Ramaesh1
  1. 1Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
  2. 2Southern General Hospital, Glasgow, UK
  3. 3Department of Pathology, Western Infirmary, Glasgow, UK
  1. Correspondence to Dr Douglas A M Lyall, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Great Western Road, Glasgow G12 0YN, UK; douglas_am_lyall{at}


Aims To report long term visual outcomes, complications and graft survival of patients undergoing deep anterior lamellar keratoplasty (DALK) to treat corneal scarring secondary to herpes simplex virus (HSV) keratitis.

Methods Retrospective, non-comparative case series. 18 patients who underwent DALK for HSV keratitis related corneal scarring between January 2004 and February 2007 were included. DALK was performed by Anwar's big bubble technique. Data collected for analysis included preoperative characteristics, intraoperative complications and postoperative acuity, complications and subsequent operations.

Results Mean best corrected distance visual acuity (LogMAR) improved from 1.51±0.90 preoperatively to 0.82±0.85 at the last follow-up (p=0.05). 27% of patients with more than 4 years follow-up had a best corrected distance visual acuity of 6/12 or better and 64% were 6/24 or better. Six patients (33%) experienced a recurrence of HSV keratitis and 9 (50%) experienced an episode of graft rejection. There were five cases (28%) of graft failure, four of whom had had a previous episode of graft rejection. Logistic regression did not find an association with graft rejection, HSV recurrence, any other observed postoperative host corneal vascularisation and any postoperative complication. The majority of patients underwent a second operation with 50% requiring cataract surgery.

Conclusions DALK for the treatment of HSV related corneal scarring is associated with a high percentage of postoperative complications. DALK in this context is also associated with a large percentage of secondary operations. Patients should be aware of this when giving informed consent for DALK to treat HSV related corneal scars.

  • Lamellar keratoplasty
  • DALK
  • herpes simplex
  • corneal scarring
  • graft survival
  • cornea
  • visual (cerebral) cortex
  • optic nerve
  • physiology
  • visual pathway
  • vision

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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