title: Long-term comparison of full-bed deep lamellar keratoplasty with penetrating keratoplasty in treating corneal leucoma caused by herpes simplex keratitis.
abstract: OBJECTIVE
  To compare long-term outcomes of full-bed deep lamellar keratoplasty (DLK) with penetrating keratoplasty (PK) for treating corneal leucoma caused by herpes simplex keratitis (HSK).
  
  
  METHODS
  Retrospective, comparative, interventional case series.
  
  
  METHODS
  setting: Institutional. patients: Inclusion criteria were patients with corneal scarring induced exclusively by HSK who underwent primary graft of full-bed DLK or PK and completed a minimum of 12 months postoperative follow-up. There was no significant difference of corneal scarring and vascularization between the 2 groups before surgery. Choosing PK or full-bed DLK depended on the patient's own willingness, except those patients with a preoperative endothelial cell count of less than 700 cells/mm(2) or whose endothelial cell count was undetectable were encouraged to undergo only PK. Exclusion criteria were patients with a past history of corneal perforation, nonprimary graft, non-HSK-related corneal scars, and failure to complete a minimum of 12 months of postoperative follow-up. Fifty-eight eyes of 58 patients in the full-bed DLK group and 63 eyes of 63 patients in the PK group met the inclusion criteria. main outcome measures: Postoperative managements, recurrence of HSK, graft rejection, graft survival rate, visual acuity, and corneal endothelial density.
  
  
  RESULTS
  The mean postoperative follow-up duration was 45.8 ± 30.9 months in the full-bed DLK group and 47.9 ± 27.2 months in the PK group (P = .70). As compared with the PK group, the full-bed DLK group experienced earlier suture removal (P = .01), needed fewer postoperative visits (P < .001), and had a higher proportion of eyes with full withdrawal of oral acyclovir (P < .001) and topical corticosteroid (P < .001). There were a total of 21 episodes of recurrent HSK in the PK group, more frequent than the 7 episodes in the full-bed DLK group, among which recurrent epithelial keratitis amounted to 13 episodes in the PK group, remarkably more frequent than the 1 episode in the full-bed DLK group. Twenty-six eyes (41.3%) encountered rejection episodes in the PK group, but no rejection episode was found in the full-bed DLK group (P < .001). In 14 eyes in the PK group, graft failure developed because of graft rejection, recurrence of HSK, or both, whereas only in 1 eye in the full-bed DLK group did graft failure develop because of recurrence of HSK (P = .001). The clear graft survival rate in the full-bed DLK group was significantly higher than that in the PK group (P = .01). Corneal endothelial cell density was stable from 1 month through 5 years in the full-bed DLK group, but 51.3% cell loss was found in the PK group at 5 years after surgery. At the last visit, 66.1% of eyes with full-bed DLK grafts and 50.9% of eyes with PK grafts achieved a best-correct visual acuity of 0.5 or better (P = .10).
  
  
  CONCLUSIONS
  Advantages of full-bed DLK over PK are no allograft rejection, longer graft survival, earlier drug withdrawal of topical steroid and oral acyclovir, less recurrence of HSK, and fewer follow-up visits. Full-bed DLK is preferable for treating HSK-induced corneal scarring with relatively healthy endothelium and with no history of perforation.
authors: Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, People's Republic of China.
authors: Shuang-Qing
authors: SQ
authors: Wu
authors: Ping
authors: P
authors: Zhou
authors: Bei
authors: B
authors: Zhang
authors: Wen-Ya
authors: WY
authors: Qiu
authors: Yu-Feng
authors: YF
authors: Yao
mesh_terms: D000328:Adult; D002452:Cell Count; D003318:Corneal Opacity / Q000503:physiopathology / Q000601:surgery* / Q000821:virology; D016039:Corneal Transplantation; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016849:Keratitis, Herpetic / Q000503:physiopathology / Q000601:surgery* / Q000821:virology; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology