title: Deep anterior lamellar keratoplasty using irradiated acellular cornea with amniotic membrane transplantation for intractable ocular surface diseases.
abstract: OBJECTIVE
  To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) when sterile gamma-irradiated acellular corneal tissues (VisionGraft) are used in combination with amniotic membrane transplantation (AMT) for intractable ocular surface diseases.
  
  
  METHODS
  The medical records of fifteen patients who had DALK with AMT were retrospectively reviewed. Indications for surgery included ocular burn, bacterial keratitis, herpes simplex virus keratitis, corneal opacity with Stevens-Johnson syndrome, Mooren's ulcer, idiopathic myxoid degeneration of corneal stroma, and recurrent band keratopathy. DALK was performed using partial-thickness acellular corneal tissue and a temporary amniotic membrane patch was added at the end of the operation.
  
  
  RESULTS
  All cases that underwent DALK with AMT became epithelialized within 2 postoperative weeks. Twelve patients showed favorable outcomes without graft rejection, corneal opacification, or neovascularization. The other three grafts developed corneal opacification and neovascularization, and required additional penetrating keratoplasty (PK). Unlike the results of previous PKs, there were no graft rejections and the graft clarity was well-maintained in these three cases for at least 8 months after PK.
  
  
  CONCLUSIONS
  DALK using sterile acellular corneal tissues in combination with AMT may be a good therapeutic strategy for treating intractable ocular surface diseases because of lowered immune rejection, fibroblast activation, and facilitation of epithelialization. Furthermore, DALK can help stabilize the ocular surface, prolong graft survival, and may allow better outcomes when combined with subsequent PK.
authors.affiliation: Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Wee
authors.affiliation: Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Sang Uk
authors.initials: SU
authors.lastname: Choi
authors.affiliation: Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Jae Chan
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D003319:Corneal Stroma / Q000528:radiation effects / Q000637:transplantation*; D005260:Female; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity; D055815:Young Adult
keywords: Amniotic membrane transplantation; Deep anterior lamellar keratoplasty; Intractable ocular surface disease; Sterile acellular cornea; Visiongraft
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