title: Long-term graft survival in deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To determine corneal graft survival rates up to 10 years in a large consecutive series of deep anterior lamellar keratoplasties (DALKs).
  
  
  METHODS
  A retrospective, consecutive, noncomparative cases series of DALK procedures in a total of 806 eyes of 711 patients with stromal diseases and healthy endothelium performed between 2000 and 2009. Inclusion criterion was surgery performed by a single surgeon (660 eyes), with at least 6 months of follow-up. Graft survival was analyzed using the Kaplan-Meier method. Endothelial loss was analyzed with the Gaussian distribution and the χ methods. Follow-up time, and preoperative and postoperative endothelial cell density (ECD) were considered in the analyses.
  
  
  RESULTS
  Six hundred sixty eyes of 502 patients met the entry criteria. Mean length of follow-up was 4.5 years (range, 0.5-10 years). We report an average graft survival rate of 99.3% (range, 98.5%-100%); 3 eyes (0.45%) experienced graft failure and 1 eye (0.15%) developed late endothelial failure because of an intraoperative complication. Predominant indications for DALK in this series were keratoconus (74%), postherpetic keratitis scarring (15%), and corneal stromal opacities of different etiology (11%). Endothelial loss from preoperative levels averaged 11% (range, 10%-13%) at 6 months through 10 years after DALK. ECD was unchanged between 6 months postoperatively and the last follow-up visits.
  
  
  CONCLUSIONS
  DALK is a successful form of transplantation in stromal corneal disorders with healthy endothelium, with higher long-term graft survival rates and stable ECD 6 months postoperatively. DALK survival rates do not vary significantly over time.
authors.affiliation: Department of Ophthalmology, Misericordia Hospital, Grosseto, Italy. v.sarnicola@hotmail.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Sarnicola
authors.forename: Patricia
authors.initials: P
authors.lastname: Toro
authors.forename: Caterina
authors.initials: C
authors.lastname: Sarnicola
authors.forename: Enrica
authors.initials: E
authors.lastname: Sarnicola
authors.forename: Andrew
authors.initials: A
authors.lastname: Ruggiero
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology* / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000473:pathology; D003319:Corneal Stroma / Q000473:pathology; D016039:Corneal Transplantation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications; D016849:Keratitis, Herpetic / Q000601:surgery; D007640:Keratoconus / Q000601:surgery; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult