title: Anterior lamellar keratoplasty over penetrating keratoplasty for optical, therapeutic, and tectonic indications: a case series.
abstract: OBJECTIVE
  To report a consecutive case series of patients who underwent anterior lamellar keratoplasty (ALK) over a preexisting penetrating keratoplasty (PK).
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  Eight patients (8 eyes) were identified from the Singapore Corneal Transplant Study database, in a single institution (Singapore National Eye Center) from patients who underwent ALK performed over a PK. Main outcome measures were final visual acuity (VA), graft failure (ALK, PK or both), successful restoration of tectonic integrity in tectonic indications, and eradication of infection in therapeutic cases.
  
  
  RESULTS
  The indications for surgery were therapeutic in 3 patients, optical in 3 patients, and tectonic in 2 patients. Postoperatively the best-corrected visual acuity (BCVA) improved in 5 eyes and remained unchanged in 3 eyes. Mean VA improved significantly after ALK; the mean preoperative BCVA was 1.52 +/- 0.25 and the mean postoperative BCVA was 0.87 +/- 0.26 (P = .032). Three of the 8 eyes post-lamellar keratoplasty (LK) managed to attain a BCVA equal to post-PK BCVA. Two patients had suture micro-perforations while 1 patient required a repeat ALK for recurrence of infection.
  
  
  CONCLUSIONS
  ALK may be a considered as a viable alternative to a repeat PK for a variety of optical, therapeutic, and tectonic indications.
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ang
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
authors.forename: Anshu
authors.initials: A
authors.lastname: Arundhati
authors.forename: Donald T H
authors.initials: DT
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000503:physiopathology / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology