title: Results of Deep Anterior Lamellar Keratoplasty for Advanced Keratoconus in Children Less Than 18 Years.
abstract: OBJECTIVE
  To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children with advanced keratoconus.
  
  
  METHODS
  Retrospective noncomparative interventional case series.
  
  
  METHODS
  A retrospective analysis was conducted of 20 eyes of 16 patients who underwent deep anterior lamellar keratoplasty at a tertiary eye care center for advanced keratoconus. The main preoperative parameters measured were decimal uncorrected visual acuity (UCVA), decimal best-corrected visual acuity (BCVA), and average keratometry. The average keratometry was taken as an average of the flat and steep keratometric readings. The follow-up ranged from 24 to 105 months. The main outcome measures were UCVA, BCVA, steep and flat simulated keratometry, refraction, graft clarity, and complications.
  
  
  RESULTS
  At the final follow-up, 18 patients had clear grafts in the visual axis area. Mean decimal UCVA changed from 0.06 ± 0.08 to 0.24 ± 0.09. Mean decimal BCVA changed from 0.12 ± 0.19 to 0.45 ± 0.24. The average keratometry decreased from 64.15 diopter (D) to 45.7 D after surgery. The complications noted in the patients were graft rejection (1), shield ulcers (2), graft infection (2), and interface vascularization (4). They were managed accordingly and only 1 patient needed penetrating keratoplasty.
  
  
  CONCLUSIONS
  DALK is an effective therapeutic modality for the management of advanced keratoconus in children.
authors.affiliation: Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
authors.forename: Ritu
authors.initials: R
authors.lastname: Arora
authors.affiliation: Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India. Electronic address: drpoojajain1@gmail.com.
authors.forename: Pooja
authors.initials: P
authors.lastname: Jain
authors.affiliation: Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
authors.forename: Parul
authors.initials: P
authors.lastname: Jain
authors.affiliation: Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Manudhane
authors.affiliation: Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
authors.forename: JawaharLal
authors.initials: J
authors.lastname: Goyal
mesh_terms: D000293:Adolescent; D002452:Cell Count; D002648:Child; D063171:Corneal Pachymetry; D016039:Corneal Transplantation; D004728:Endothelium, Corneal / Q000166:cytology; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology