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Therapeutic DALK may be better option than therapeutic PK in stromal-confined keratitis

Ophthalmology. 2009;116(4):615-623.

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Therapeutic deep anterior lamellar keratoplasty may be a better option than therapeutic penetrating keratoplasty in cases of infectious keratitis confined to the stroma.

In a study of 26 eyes undergoing therapeutic DALK and 100 eyes undergoing therapeutic PK, therapeutic success was similar in the two groups (84.6% vs. 88%). However, a higher proportion of patients in the therapeutic DALK group achieved best corrected visual acuity of at least 6/9 (50%) compared with patients in the therapeutic PK group (20.2%; P = .01).

Mean improvement in number of lines gained was also better in the therapeutic DALK group (7.27) compared with the therapeutic PK group (4.76; P = .01). At 1 year, graft survival rate in the therapeutic DALK group was 90% compared with 78.4% in the therapeutic PK group.

The study authors said that in cases of infectious keratitis confined to the stroma and unresponsive to antimicrobial therapy, therapeutic DALK can be performed earlier in the disease course than therapeutic PK, which may further improve outcomes.