Long-term outcomes of deep anterior lamellar versus penetrating keratoplasty for keratoconus
Reviewed by Jonathan Chan

This is a retrospective consecutive and comparative case series of keratoplasties (228 deep anterior lamellar keratoplasties (DALKs) and 274 penetrating keratoplasties (PKs)) in a single centre by one surgeon in France, between 1993 and 2021. Graft survival was 96.7% at 10 years and 95.6% at 20 years. Visual acuity improved from 20.378 ±5.1 lines preoperatively to 20/32 ±2.1 lines at 30 months. The corneal endothelial cell density (ECD) decreased from 2494 ±382 cells/mm square to 1521 ±659 cells/mm square at 10 years (50% lower of ECD loss in DLAKs than PKs group). The mean simulated keratometry increased from 44.88 ±n2.54 D at one year to 46.6 ±3 D at three years. The mean follow-up was 103.4 months for DALKs and 106.1 months for PKs. The cumulative incidence of postoperative ocular hypertension requiring treatment was significantly higher in PKs than in DALKs. No significant differences in visual acuity were observed between the two groups. The authors concluded that DALK should be preferred to PK for treating keratoconus.

Long-term outcomes of deep anterior lamellar versus penetrating keratoplasty for keratoconus.
Borderie VM, Georgeon C, Sandali O, Bouheraoua N.
BRITISH JOURNAL OF OPHTHALMOLOGY
2024;108:10–6.