Retrospective analysis of deep lamellar keratoplasties

Background: Purpose of this retrospective study was to analyse the outcome of deep lamellar keratoplasty. Patients and methods: The records of 9 patients with deep lamellar keratoplasty were reviewed. Age, sex, systemic diseases, indication for surgery, pre- and postoperative visual acuity and findings, visual acuity and findings at last follow-up and complications were noted. Results: Nine eyes of 9 patients have been operated with the "big bubble" technique described by Anwar. Indications for operation were keratoconus (4), keratoglobus (1), central corneal scar after keratitis (3) and after alkali burn (1). In 3 cases the intraoperative technique had to be changed to penetrating keratoplasty. The preoperative visual acuity was 0.2 to 0.3. All 9 patients showed a postoperative improvement of visual acuity: best corrected from 0.3 to 0.8. In one eye particles in the interface were found. At last follow-up all grafts were clear. There were no postoperative complications. Conclusions: The results demonstrate that deep lamellar keratoplasty is a technically difficult procedure, in 3 out of 9 patients the operation method failed. The postoperative course after deep lamellar keratoplasty did not show any severe complications. The patients who had to be changed to penetrating keratoplasty were not disadvantaged in respect of the final result (visual acuity and findings). The postoperative visual acuities after deep lamellar keratoplasty and after penetrating keratoplasty were comparable. Despite the small number of patients and the relatively short observation period, we noticed that after deep lamellar keratoplasty the sutures could tendentially be removed earlier and thus the duration of topic steroids therapy was shorter compared to penetrating keratoplasty.