title: Peripheral deep anterior lamellar keratoplasty using a cryopreserved donor cornea for Terrien's marginal degeneration.
abstract: OBJECTIVE
  To evaluate the clinical efficacy of peripheral deep anterior lamellar keratoplasty (DALK) using a cryopreserved donor cornea for Terrien's marginal degeneration (TMD).
  
  
  METHODS
  Thirty-one eyes of 27 patients with TMD underwent peripheral DALK using cryopreserved donor corneas. According to the distance between the inner edge of the lesion and the limbus, a ring-shaped or D-shaped DALK was performed. All grafts were stored at -20 °C. Cryopreserved corneoscleral rims were prepared for ring-shaped grafts and cryopreserved whole eyeballs were prepared for D-shaped grafts. The general conditions, intraoperative performance, postoperative corneal reconstruction, astigmatism, best corrected visual acuity (BCVA), and various complications were analyzed.
  
  
  RESULTS
  Ring-shaped DALK was performed in 28 eyes and D-shaped DALK was performed in 3 eyes. Postoperative follow-up time was (28.4±24.8) months. There was evidence of inflammation before surgery in 12 eyes (38.7%) and intraoperative perforation occurred in 13 eyes (41.9%). The corneal structures of all eyes were reconstructed. Postoperative astigmatism and BCVA showed improvement (both P=0.00) except for cases that underwent D-shaped DALK. Ten eyes (32.2%) developed transient ocular hypertension and one eye (3.2%) developed secondary glaucoma. No primary disease recurrence or corneal allograft rejection was observed.
  
  
  CONCLUSIONS
  Peripheral DALK for TMD using cryopreserved donor tissue is an effective technique that eliminates rejection and extends the use of donor eyes. Inflammatory history or intraoperative perforation has no adverse effect on graft recovery. However, D-shaped DALK did not achieve good visual outcomes.
authors.affiliation: Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Huang
authors.forename: Wen-ya
authors.initials: WY
authors.lastname: Qiu
authors.forename: Bei
authors.initials: B
authors.lastname: Zhang
authors.forename: Bing-hong
authors.initials: BH
authors.lastname: Wang
authors.forename: Yu-feng
authors.initials: YF
authors.lastname: Yao
mesh_terms: D000328:Adult; D003315:Cornea / Q000502:physiology; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D015925:Cryopreservation; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension; D011183:Postoperative Complications; D011184:Postoperative Period; D012008:Recurrence; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
keywords: Cryopreservation; Deep anterior lamellar keratoplasty (DALK); Terrien’s marginal degeneration (TMD)