title: Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus.
abstract: OBJECTIVE
  To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus.
  
  
  METHODS
  Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups.
  
  
  RESULTS
  A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006).
  
  
  CONCLUSIONS
  Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.
authors: Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
authors: Yong-ming
authors: YM
authors: Zhang
authors: Shuang-qing
authors: SQ
authors: Wu
authors: Yu-feng
authors: YF
authors: Yao
mesh_terms: D002681:China / Q000453:epidemiology; D015897:Comorbidity; D016039:Corneal Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005901:Glaucoma / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007640:Keratoconus / Q000175:diagnosis / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D009798:Ocular Hypertension / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D016896:Treatment Outcome; D055815:Young Adult
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