Deep anterior lamellar keratoplasty over penetrating keratoplasty for host rim thinning and ectasia

Cornea. 2009 Jun;28(5):489-92. doi: 10.1097/ICO.0b013e31818d3b3c.


Purposes: To describe the technique and evaluate the outcomes of patients who had deep anterior lamellar keratoplasty (DALK) for ectasia within or outside the graft-host interface in a previous penetrating keratoplasty (PK).

Design: Retrospective review of interventional case series.

Patients: Seven eyes that underwent DALK for corneal ectasia after previous PK.

Intervention: DALK encompassing the area of ectasia and the previous PK.

Main outcome measures: Uncorrected visual acuity, best spectacle-corrected visual acuity, keratometry and topography, and complications.

Results: Seven eyes had DALK, 4 developed Descemet membrane tears, and 2 eyes had deep graft-host dehiscence from the previous PK intraoperatively. At 12 months, mean uncorrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.157 to 0.74. Mean best spectacle-corrected visual acuity improved from 0.82 to 0.37 at 12 months.

Conclusions: DALK can be successfully performed over a previous PK. Intraoperative Descemet tears or dehiscence of Descemet at the previous graft-host interface can complicate surgery, but if successfully managed can produce a significant improvement in visual acuity.

MeSH terms

  • Adult
  • Corneal Diseases / diagnosis*
  • Corneal Diseases / etiology*
  • Corneal Diseases / surgery*
  • Corneal Topography
  • Corneal Transplantation / adverse effects
  • Corneal Transplantation / methods*
  • Dilatation, Pathologic / diagnosis
  • Dilatation, Pathologic / surgery
  • Eyeglasses
  • Female
  • Humans
  • Keratoplasty, Penetrating / adverse effects*
  • Male
  • Middle Aged
  • Reoperation
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity