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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-09-2018 | Cornea

Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty

Authors: Matthias Fuest, Sharita R. Siregar, Abdelsattar Farrag, Hla Myint Htoon, Donald Tan, Jodhbir S. Mehta

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 9/2018

Abstract

Aims

To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of infection and residual stromal opacity.

Methods

Ten eyes of nine consecutive patients undergoing DALK after DSAEK at a single tertiary referral center (SNEC) from 2011 to 2016 were analyzed for best spectacle-corrected visual acuity (BSCVA), refraction, spherical equivalent (SE) and cylinder, as well as graft diameters, survival, and complications.

Results

The mean pre-DSAEK BSCVA was 1.73 ± 0.76 LogMAR. At a mean follow-up of 9.8 ± 7.1 months, visual acuity had improved significantly (p = 0.028) to 1.09 ± 0.55 LogMAR after DSAEK. DALK was performed at 10.3 ± 7.2 months after DSAEK because of residual stromal scarring in nine and a corneal infection in one case. At the last follow-up visit (19.4 ± 13.9 months) after DALK, BSCVA had improved to 0.38 ± 0.6 LogMAR, significantly better than after DSAEK alone (p = 0.015) and before DSAEK (p = 0.018). Spherical equivalent (− 4.8 ± 3.5 D) and cylinder (− 2.5 ± 2.0 D) did not show significant changes compared to after DSAEK (SE p = 0.17; cylinder p = 0.19) or 3 months after DALK (SE p = 0.17; cylinder p = 0.46). One endothelial graft failed 3 months after DALK. Kaplan-Meier estimated average survival for all cases was 45.3 (95% CI 36.6–54.0) months. The cumulative survival probability for the entire cohort was 90% at 1, 2, and 4 years of follow-up.

Conclusions

DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.

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Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM (2009) Descemet’s stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology 116:1818–1830. https://doi.org/10.1016/j.ophtha.2009.06.021 CrossRefPubMed

Anshu A, Price MO, Tan DT, Price FW Jr (2012) Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol 57:236–252. https://doi.org/10.1016/j.survophthal.2011.10.005 CrossRefPubMed

Li JY, Terry MA, Goshe J, Davis-Boozer D, Shamie N (2012) Three-year visual acuity outcomes after Descemet’s stripping automated endothelial keratoplasty. Ophthalmology 119:1126–1129. https://doi.org/10.1016/j.ophtha.2011.12.037 CrossRefPubMed

Morishige N, Sonoda KH (2013) Bullous keratopathy as a progressive disease: evidence from clinical and laboratory imaging studies. Cornea 32(Suppl 1):S77–S83. https://doi.org/10.1097/ICO.0b013e3182a1bc65 CrossRefPubMed

Ang M, Lim F, Htoon HM, Tan D, Mehta JS (2016) Visual acuity and contrast sensitivity following Descemet stripping automated endothelial keratoplasty. Br J Ophthalmol 100:307–311. https://doi.org/10.1136/bjophthalmol-2015-306975 CrossRefPubMed

Al-Mezaine H, Wagoner MD (2006) Repeat penetrating keratoplasty: indications, graft survival, and visual outcome. Br J Ophthalmol 90:324–327. https://doi.org/10.1136/bjo.2005.079624 CrossRefPubMedPubMedCentral

Keane M, Coster D, Ziaei M, Williams K (2014) Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus. Cochrane Database Syst Rev CD009700. https://doi.org/10.1002/14651858.CD009700.pub2

Busin M, Beltz J (2011) Deep anterior lamellar keratoplasty after descemet stripping automated endothelial keratoplasty. Cornea 30:1048–1050. https://doi.org/10.1097/ICO.0b013e318207ec97 CrossRefPubMed

Pang A, Mohamed-Noriega K, Chan AS, Mehta JS (2014) Confocal microscopy findings in deep anterior lamellar keratoplasty performed after Descemet’s stripping automated endothelial keratoplasty. Clin Ophthalmol 8:243–249. https://doi.org/10.2147/OPTH.S54824 CrossRefPubMedPubMedCentral

10.

Gutfreund S, Leon P, Graffi S, Busin M (2017) Deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 175:129–136. https://doi.org/10.1016/j.ajo.2016.12.012 CrossRefPubMed

11.

Tan DT, Janardhanan P, Zhou H, Chan YH, Htoon HM, Ang LP, Lim LS (2008) Penetrating keratoplasty in Asian eyes: the Singapore corneal transplant study. Ophthalmology 115(975–982):e971. https://doi.org/10.1016/j.ophtha.2007.08.049 CrossRef

12.

Ang M, Saroj L, Htoon HM, Kiew S, Mehta JS, Tan D (2014) Comparison of a donor insertion device to sheets glide in Descemet stripping endothelial keratoplasty: 3-year outcomes. Am J Ophthalmol 157(1163–1169):e1163. https://doi.org/10.1016/j.ajo.2014.02.049 CrossRef

13.

Khor WB, Han SB, Mehta JS, Tan DT (2013) Descemet stripping automated endothelial keratoplasty with a donor insertion device: clinical results and complications in 100 eyes. Am J Ophthalmol 156:773–779. https://doi.org/10.1016/j.ajo.2013.05.012 CrossRefPubMed

14.

Ang M, Ho H, Wong C, Htoon HM, Mehta JS, Tan D (2014) Endothelial keratoplasty after failed penetrating keratoplasty: an alternative to repeat penetrating keratoplasty. Am J Ophthalmol 158(1221–1227):e1221. https://doi.org/10.1016/j.ajo.2014.08.024 CrossRef

15.

Mitry D, Bhogal M, Patel AK, Lee BS, Chai SM, Price MO, Price FW Jr, Jun AS, Aldave AJ, Mehta JS, Busin M, Allan BD (2014) Descemet stripping automated endothelial keratoplasty after failed penetrating keratoplasty: survival, rejection risk, and visual outcome. JAMA Ophthalmol 132:742–749. https://doi.org/10.1001/jamaophthalmol.2014.352 CrossRefPubMed

16.

Hindman HB, Huxlin KR, Pantanelli SM, Callan CL, Sabesan R, Ching SST, Miller BE, Martin T, Yoon G (2013) Post DSAEK optical changes: a comprehensive prospective analysis on the role of ocular wavefront aberrations, haze, and corneal thickness. Cornea 32:1567–1577. https://doi.org/10.1097/ICO.0b013e3182a9b182 CrossRefPubMedPubMedCentral

17.

Heinzelmann S, Bohringer D, Maier PC, Reinhard T (2014) Correlation between visual acuity and interface reflectivity measured by pentacam following DSAEK. Acta Ophthalmol 92:e1–e4. https://doi.org/10.1111/aos.12217 CrossRefPubMed

18.

De Benito-Llopis L, Mehta JS, Angunawela RI, Ang M, Tan DT (2014) Intraoperative anterior segment optical coherence tomography: a novel assessment tool during deep anterior lamellar keratoplasty. Am J Ophthalmol 157:334–341 e333. https://doi.org/10.1016/j.ajo.2013.10.001

19.

Savastano A, Sbordone S, Piccirillo V, Forte R, Tamburini L, Savastano MC, Savastano S (2009) Confocal microscopy after descemet stripping endothelial keratoplasty: a case report. Cornea 28:570–574. https://doi.org/10.1097/ICO.0b013e3181896784 CrossRefPubMed

20.

Kobayashi A, Mawatari Y, Yokogawa H, Sugiyama K (2008) In vivo laser confocal microscopy after descemet stripping with automated endothelial keratoplasty. Am J Ophthalmol 145:977–985. https://doi.org/10.1016/j.ajo.2008.02.009 CrossRefPubMed

21.

Feizi S, Javadi MA, Kanavi MR (2010) Cellular changes of donor corneal tissue after deep anterior lamellar keratoplasty versus penetrating keratoplasty in eyes with keratoconus: a confocal study. Cornea 29:866–870. https://doi.org/10.1097/ICO.0b013e3181ca2ed6 CrossRefPubMed

22.

Feizi S, Javadi MA, Kanavi MR, Javadi F (2014) Effect of donor graft quality on clinical outcomes after deep anterior lamellar keratoplasty. Cornea 33:795–800. https://doi.org/10.1097/ico.0000000000000177 CrossRefPubMed

23.

Claesson M, Armitage WJ (2013) Clinical outcome of repeat penetrating keratoplasty. Cornea 32:1026–1030. https://doi.org/10.1097/ICO.0b013e31828a2810 CrossRefPubMed

24.

Huang T, Hu Y, Gui M, Zhang H, Wang Y, Hou C (2015) Large-diameter deep anterior lamellar keratoplasty for keratoconus: visual and refractive outcomes. Br J Ophthalmol 99:1196–1200. https://doi.org/10.1136/bjophthalmol-2014-306170 CrossRefPubMed

25.

Han DC, Mehta JS, Por YM, Htoon HM, Tan DT (2009) Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol 148(744–751):e741. https://doi.org/10.1016/j.ajo.2009.05.028 CrossRef

26.

Romano V, Iovieno A, Parente G, Soldani AM, Fontana L (2015) Long-term clinical outcomes of deep anterior lamellar keratoplasty in patients with keratoconus. Am J Ophthalmol 159:505–511. https://doi.org/10.1016/j.ajo.2014.11.033 CrossRefPubMed

27.

Patel SV, McLaren JW, Hodge DO, Bourne WM (2001) Normal human keratocyte density and corneal thickness measurement by using confocal microscopy in vivo. Invest Ophthalmol Vis Sci 42:333–339PubMed

28.

Armitage WJ, Jones MN, Zambrano I, Carley F, Tole DM (2014) The suitability of corneas stored by organ culture for penetrating keratoplasty and influence of donor and recipient factors on 5-year graft survival. Invest Ophthalmol Vis Sci 55:784–791. https://doi.org/10.1167/iovs.13-13386 CrossRefPubMed

29.

Anshu A, Parthasarathy A, Mehta JS, Htoon HM, Tan DT (2009) Outcomes of therapeutic deep lamellar keratoplasty and penetrating keratoplasty for advanced infectious keratitis: a comparative study. Ophthalmology 116:615–623. https://doi.org/10.1016/j.ophtha.2008.12.043 CrossRefPubMed

30.

Bahar I, Kaiserman I, McAllum P, Slomovic A, Rootman D (2008) Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology 115:1525–1533. https://doi.org/10.1016/j.ophtha.2008.02.010 CrossRefPubMed

Title: Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty
Authors: Matthias Fuest
Sharita R. Siregar
Abdelsattar Farrag
Hla Myint Htoon
Donald Tan
Jodhbir S. Mehta
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 9/2018
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-018-3997-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty

Abstract

Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aims

Methods

Results

Conclusions

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