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Study: DLKP superior to PK in safety concerns

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CHIBA, Japan — Deep lamellar keratoplasty is superior to penetrating keratoplasty in safety, according to a study here. The lamellar procedure may be preferred in some corneal transplant candidates whose endothelia are still healthy, the authors suggest.

The authors said the non-penetrating approach is “strongly recommended for high-risk cases such as eyes with corneal neovascularization.”

Jun Shimazaki, MD, and colleagues here randomly assigned 26 eyes of 24 patients who had stromal opacity without endothelial abnormalities to either deep lamellar keratoplasty (DLKP) or penetrating keratoplasty (PKP). Best corrected visual acuity (BCVA), contrast visual acuity, glare test, intraocular pressure, corneal topography, endothelial density and pachymetry were measured both preoperatively and postoperatively.

BCVA stabilized in the DLKP group at about 6 months postop and at about 3 months postop in the PKP group, but this difference was not statistically significant.

In the DLKP group, Descemet’s membrane was perforated during surgery in two eyes, leading to detachment of the membrane postop. All eyes had normal IOP preop and were not on anti-glaucoma medications. One year postop, one eye in the DLKP group and five eyes in the PKP group used anti-glaucoma medications. IOP at 12 months was significantly higher in the PKP group compared with preop values (P = .004), but that was not the case with the DLKP group.

The PKP group showed a progressive decrease in endothelial density over 24 months postop; the DLKP group showed initial loss for 6 months, which subsequently stabilized. At the 2 year follow-up, the difference became statistically significant (P = .044). “It is probable that the difference will become greater with time,” the authors reported.

“It should be noted, however, that DLKP is not free of endothelial damage. Even in uncomplicated cases, approximately 25% loss of endothelial damage was noted,” they noted.

The study is published in the August issue of American Journal of Ophthalmology.