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Keys to optimal visual acuity in two types of DALK established
Cornea. 2011;30(11):1244-1252.
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Depth of the lamellar bed, smoothness and the healing process at the lamellar interface are important in obtaining ideal visual acuity in deep anterior lamellar keratoplasty, a study found.
Researchers evaluated the confocal microscopic features of the lamellar interface after two types of DALK and compared clinical findings. The two techniques evaluated were Descemetic with total stromal resection and pre-Descemetic with deep stromal dissection.
The study consisted of 20 eyes that had corneal disease with healthy endothelium and were treated with DALK. The study population was broken down into a Descemetic group with 12 eyes that experienced baring of the Descemet membrane and a pre-Descemetic group with eight eyes that had a fine stromal layer left after surgery.
Visual acuity, interface clarity, corneal topography, confocal microscopy and endothelial cell count were evaluated.
Overall, two eyes experienced Descemet membrane microperforation. One eye had presumed stromal rejection and was excluded from the study. No eyes were converted to penetrating keratoplasty intraoperatively.
In the Descemetic group, 90.9% of eyes achieved final best corrected visual acuity of 20/30 or better compared with 75% that achieved final BCVA of 20/30 in the pre-Descemetic group. The researchers did not find any statistically significant difference in mean visual outcomes between the groups. The reflectivity of activated keratocytes at the interface was less in the Descemetic group.
Keratocyte morphology and reflectivity returned to normal 10 to 12 weeks after pre-Descemetic DALK and 4 to 6 weeks after Descemetic DALK.
"Although dissection to bare [Descemet membrane] is more difficult, keratocyte activation and interface haze were less, but differences in final visual acuity were not significant," according to the study.