DALK has good long-term outcomes in children with partial-thickness corneal pathologies
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NEW ORLEANS — Children younger than 14 years of age who had partial-thickness corneal pathologies benefited long term from deep anterior lamellar keratoplasty, according to a presentation.
Muralidhar Ramappa, MD, and colleagues analyzed outcomes of 171 eyes of 151 patients (median age, 4.3 years) who underwent DALK between 2007 and 2021.
DALK was performed for keratoconus in 58 eyes, acquired infections in 57 eyes, corneal keloid in 15 eyes, mucopolysaccharidosis in 15 eyes, limbal dermoid in 11 eyes and other indications in 15 eyes. Manual lamellar separation was used in 135 cases (73.4%), and most eyes underwent DALK alone.
At a median follow-up of 15 months, mean best corrected visual acuity improved from 1.18 logMAR to 0.8 logMAR (P < .0001). The mean spherical equivalent refraction at final follow-up was –2.02 D.
Grafts were clear in 83.6% of eyes at a median of 2.5 years, with a predicted graft survival of 86.3% at 1 year and 77.2% at 5 years.
“Overall, the long-term graft survival outcomes are satisfactory with excellent visual outcomes considering that this cohort underwent transplantation in an early phase of technique development,” according to the presentation.
Common complications were graft infection in 15 cases, cataract formation in 14 cases, Descemet’s membrane detachment in 10 cases, herpes simplex virus recurrence in nine cases and stromal graft rejection in eight cases. There was one graft failure due to consistent Descemet’s membrane detachment.
“DALK provides superior long-term clinical outcomes with low complication rates, suggesting that DALK is a safe and effective surgical alternative in children with partial-thickness corneal diseases,” according to the presentation. “Notably, it helps in better long-term functional outcomes by minimizing the risk of allograft rejection.”
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Ramappa M. Long-term outcomes of deep anterior lamellar keratoplasty (DALK) in children: a 14 year experience. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
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