Original articleRandomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty1
Section snippets
Design
The study was conducted in a prospective, randomized fashion. Patients were randomly assigned based on a surgical chart number (patients with even numbers were assigned to PKP and with odd numbers to DLKP) to receive either PKP (PKP group) or DLKP (DLKP group). All donor corneas were transported from eye banks in the United States, and met the criteria of the Eye Bank Association of America for donor quality.
Methods
Patients requiring keratoplasty for corneal stromal opacity without endothelial disease were enrolled between December 1996 and November 1998 in the Department of Ophthalmology, Tokyo Dental College. All patients received explanation about the purpose of the study as well as advantages and disadvantages of both PKP and DLKP. Informed consent was obtained from all patients who agreed to participate in the study. Eyes that required additional surgery such as cataract extraction simultaneously
Graft clarity and complications
In the DLKP group, the Descemet membrane perforated during surgery in two eyes, leading to detachment of the Descemet membrane postoperatively. One eye with post-herpetic stromal opacity received injection of a mixture of air and sulfurhexafluoride (SF6) in the anterior chamber without success. The Descemet membrane was not repositioned and the eye eventually developed endothelial decompensation. The patient then had PKP 17 weeks after surgery and the graft remains clear with a CVA of 20/15.
Discussion
Deep lamellar keratoplasty was first reported by Archila and associates in 1985.7 By replacing diseased tissue with healthy donor cornea, improvement in visual acuity can be obtained, while the risk of endothelial rejection or intraocular complication can be lowered. In addition, more donor corneas can be used in DLKP since the procedure does not require a healthy donor endothelium. This is an important issue in countries where donor corneas are lacking. There have been a number of reports
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2020, Journal Francais d'OphtalmologieCitation Excerpt :In our study, topographical astigmatism values were 3.81D ± 2.1D in group 1 and 3.56D ± 1.92D in group 2 at the final visit after complete suture removal (P = 0.40). These results were comparable to those reported in previous studies [15,17–21]. In patients who underwent manual DALK, we measured RST using AS-OCT and found an average value of 36.90 ± 17.80 μm.
Development of an Instrument for Slit-lamp Examination of Donor Corneas in Preservation Medium
2024, Journal of Korean Ophthalmological SocietyCorneal aberrations, densitometry on scheimpflug imaging, and visual acuity after deep anterior lamellar keratoplasty
2023, European Journal of Ophthalmology
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InternetAdvance publication at ajo.com April 19, 2002.