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DALK rapidly overtaking PK in popularity in terms of safety, visual outcomes, surgeon says
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HONG KONG — Deep anterior lamellar keratoplasty is fast becoming the procedure of choice due to its excellent visual results and safety profile, according to a surgeon presenting here.
Donald TH Tan, MBBS, FRCSG, FRCSE, FRCOphth, FAMS, told attendees of the World Ophthalmology Congress that his utilization of penetrating keratoplasty (PK) has declined dramatically in favor of deep anterior lamellar keratoplasty (DALK). "I now only do PK for 25% of my patients. So this shift is occurring quite rapidly," Prof. Tan said.
The indications for DALK are varied, and the procedure can be done in most cases in which PK would be indicated. Prof. Tan said that in other parts of Asia, tectonic and therapeutic grafts are becoming increasingly prevalent.
Prof. Tan and colleagues conducted a cohort study evaluating 21 consecutive cases of therapeutic DALK (15 months follow-up), 89 nonperforated cases of therapeutic PK (23 months follow-up) and 20 perforated cases of therapeutic PK (14 months follow-up). The 21 cases of therapeutic DALK included cases of severe infection. Notably, none of these cases developed postoperative endophthalmitis. In contrast, in the therapeutic PK groups, 64% developed endophthalmitis.
DALK also has been shown to offer a better graft survival rate than PK as well as better visual results.
In another study, Prof. Tan said he and colleagues compared results from PK and two DALK techniques in 128 patients. The three groups included 64 PK patients, 31 manual DALK patients and 33 automated DALK patients.
Visual results were better with automated DALK than with either manual DALK or PK, Prof. Tan said. Of the automated DALK group, 52% had 20/20 vision, 76% had 20/30 vision and 86% had 20/40 vision postoperatively.