Original article
Comparison of Deep Lamellar Keratoplasty and Penetrating Keratoplasty for Lattice and Macular Corneal Dystrophies

https://doi.org/10.1016/j.ajo.2006.03.057Get rights and content

Purpose

To compare the therapeutic outcomes after deep lamellar keratoplasty (DLKP) and penetrating keratoplasty (PKP) in patients with lattice corneal dystrophy (LCD) and macular corneal dystrophy (MCD).

Design

Age-matched control study.

Methods

We reviewed the clinical records of 84 eyes with LCD or MCD who had DLKP (41 eyes) or PKP (43 eyes). Primary pathology consisted of 60 eyes with LCD and 24 eyes with MCD. DLKP was performed by either removing stromal tissue gradually, or by viscodissection of Descemet’s membrane. Graft clarity, best-corrected visual acuity (BCVA), endothelial density, and complications were compared between DLKP and PKP, as well as between LCD and MCD.

Results

All 84 eyes showed a postoperative improvement in visual acuity. The median final BCVA was not significantly different between PKP and DLKP groups. Endothelial cell loss rates were similar for DLKP and PKP. While the MCD-DLKP group showed progressive decrease in endothelial density, this was not observed in the LCD-DLKP group after surgery. In the DLKP group, most of the complications occurred intraoperatively or in the early phase, whereas late phase complications such as endothelial rejection and secondary glaucoma were the main complications in the PKP group.

Conclusions

PKP is no longer an automatic choice for the surgical treatment for LCD and MCD; DLKP seems to be a safe alternative. While DLKP is a favorable method for LCD, MCD may not be a good candidate, as it might show progressive decrease in the corneal endothelium postoperatively.

Section snippets

Methods

An age-matched case controlled study was undertaken whereby clinical data were retrieved from computerized databases of patients with corneal stromal dystrophy having received DLKP (41 eyes) or PKP (43 eyes) at the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan, between 1994 and 2004. These data were updated from examination of clinical records to obtain pathologic results, surgical details, and postoperative clinical course including best-corrected visual acuity (BCVA),

Graft clarity

The results of graft survival are summarized in Figure 1. At the most recent visit, 39 grafts (95.1%) were clear in the DLKP group, and 42 grafts (97.7%) were clear in the PKP group. In the DLKP group, all corneal grafts with LCD were clear until last follow-up, whereas two of 10 with MCD developed endothelial decompensation; one failed at 1.5 years without intra-/postoperative complications, the other failed at six years with microperforation treated by air injection in the anterior chamber.

Discussion

In this comparative study of DLKP vs PKP in corneal stromal dystrophy, both procedures provided similar visual outcomes and graft survival, which suggested that postoperative outcomes were successful in both procedures. However, there were several differences in the nature of the complications. In the DLKP group, most of the complications occurred intraoperatively or in the early phase, but did not influence final graft clarity because of adequate recovery. Although microperforation of Descemet

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