title: Long-term outcomes of deep anterior lamellar keratoplasty versus penetrating keratoplasty in Australian keratoconus patients.
abstract: OBJECTIVE
  The aim of this study is to compare long-term visual and surgical outcomes after performing deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus.
  
  
  METHODS
  This is a retrospective review of 73 consecutive patients with keratoconus, managed with DALK or PK, between 2000 and 2010, by a single surgeon. Data were collected on baseline parameters, best-corrected visual acuity (BCVA) in logarithm of the mean angle of resolution (logMAR), subjective refraction, graft survival, and complications.
  
  
  RESULTS
  Thirty-one (42.5%) eyes underwent a DALK, and 42 (57.5%) eyes underwent a PK. All PK-operated and 29 out of 31 (93.5%) DALK-operated eyes remained clear at the last review. Postoperative complications were significantly more frequent after PK (57.1%) than after DALK (26.5%; P = 0.0197). The mean BCVA was not significantly different for DALK (0.14 logMAR, SD 0.2) versus PK (0.05 logMAR, SD 0.11); however, eyes that underwent PK were more likely to achieve a BCVA of 0.0 logMAR (P = 0.0029). Subjective refraction and method of visual correction (spectacles or contact lenses) were similar for each group.
  
  
  CONCLUSIONS
  DALK-operated patients in this study showed similar graft survival, fewer postoperative complications, and equivalent refractive outcomes. No significant difference in the mean BCVA was noted between DALK and PK cases.
authors.affiliation: *Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; and †Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: MacIntyre
authors.forename: Sing-Pey
authors.initials: SP
authors.lastname: Chow
authors.forename: Elsie
authors.initials: E
authors.lastname: Chan
authors.forename: Alexander
authors.initials: A
authors.lastname: Poon
mesh_terms: D000328:Adult; D001315:Australia; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology