title: Deep anterior lamellar keratoplasty for keratoconus.
abstract: OBJECTIVE
  To investigate surgical outcomes after deep anterior lamellar keratoplasty (DALKP) in eyes with keratoconus.
  
  
  METHODS
  Retrospective review of 127 eyes of 118 keratoconus patients who underwent DALKP at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between January 1, 1998 and November 30, 2001. The mean age of all patients was 25.9 years (range 11-70 years). The mean follow-up for all patients was 10.9 months (range 4-61 months). Baring of Descemet's membrane (DM) during DALKP was achieved in 47 (37%) eyes; some stroma was left during operation in the remaining 80 (63%) eyes. Snellen visual acuity, intraoperative complications, and postoperative graft status were assessed.
  
  
  RESULTS
  At the last follow-up visit, 74% of all eyes were able to achieve a best-corrected visual acuity of 20/50 or better. This level of improvement was more statistically significant with baring of DM (P = 0.005). Intraoperative perforation of DM occurred in 16 (13%) cases and was statistically significant in eyes with deep corneal scars (P = 0.012). However, this perforation did not seem to have an impact on the final visual acuity (P = 0.48). Main graft-related complications included graft-host vascularization (7/127), stromal graft rejection (4/127), graft infection (1/127), and persistent epithelial defect (1/127).
  
  
  CONCLUSIONS
  Deep lamellar keratoplasty provides a safer and successful alternative to penetrating keratoplasty for keratoconus patients but remains a challenging procedure. Endothelial graft rejection is absent after DALKP. However, stromal graft rejection, although very rare, does occur.
authors: Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. atorbaq@health.net.sa
authors: Abdullah A
authors: AA
authors: Al-Torbak
authors: Saeed
authors: S
authors: Al-Motowa
authors: Abdullah
authors: A
authors: Al-Assiri
authors: Soliman
authors: S
authors: Al-Kharashi
authors: Sami
authors: S
authors: Al-Shahwan
authors: Hani
authors: H
authors: Al-Mezaine
authors: Klaus
authors: K
authors: Teichmann