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Transplantation techniques provide comparable visual outcomes in keratoconus patients
Am J Ophthalmol. 2008;146(6):905-912.
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Techniques for corneal transplantation may produce similar visual outcomes in patients with keratoconus, but differences may be seen in induced higher-order aberrations and endothelial cell density.
In a retrospective, comparative case series in 50 keratoconus patients, deep anterior lamellar keratoplasty (DALK) and manual top hat penetrating keratoplasty induced more higher-order aberrations than PK, but time to suture removal was quicker. Mean endothelial cell count at 12 months after PK was 1,454 cells/mm² compared with 2,479 cells/mm² after DALK and 2,069 cells/mm² after top hat PK.
"The mean final [best corrected visual acuity] of patients in the DALK group was 20/52 (median 20/40); in the traditional PK group, 20/41 (median 20/30); and in the [top hat] group, 20/40 (median 20/30); this difference was not statistically significant," the study authors said.
This study showed no improvement in clinical outcomes with any of the three techniques. The authors removed sutures at an earlier stage in DALK and top hat PK, but they fail to state whether this offered any advantage. This study should not change our clinical practice with respect to keratoconus because there is no clear cut advantage in any of the techniques. In addition, the study is retrospective and does not contain comparable numbers. There is a need for a proper prospective material study to compare DALK and PK.
– Michael O’Keeffe, FRCS
Mater Misericordiae Hospital, Dublin, Ireland