title: Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty Treating Posterior Stroma-Implicated Herpetic Corneal Opacities.
abstract: OBJECTIVE
  To evaluate the long-term outcomes of deep anterior lamellar keratoplasty for the management of deep stromal corneal opacities after herpes simplex keratitis (HSK) infection.
  
  
  METHODS
  Case records of patients who underwent deep anterior lamellar keratoplasty between January 2006 and June 2012 to treat HSK-related deep stromal corneal scars were retrospectively analyzed. The cases were divided into folds-on, folds-off, and no-folds groups based on the presence of stromal folds intraoperatively. The main outcome measures were best-corrected visual acuity, endothelial cell density, and complications.
  
  
  RESULTS
  A total of 89 patients (89 eyes; 54 men and 35 women; 47.1 ± 12.9 years old) were included. Based on intraoperative events, 48 eyes had no stromal folds, 27 eyes had folds that were centrally peeled off, and 14 eyes had folds that could not be peeled. The average follow-up period was 50.4 ± 12.7 months. The mean best-corrected visual acuity improved from 1.63 ± 60.52 logMAR preoperatively to 0.44 ± 0.31 logMAR at the last visit (P < 0.001). Mean postoperative endothelial cell density was 1738 ± 573 cells per square millimeter. Eight eyes experienced HSK recurrence, 3 eyes had an episode of stromal rejection, and 3 eyes developed corneal endothelial decompensation. Cases in the folds-off group had a significantly higher rate of Descemet membrane microperforations compared with the other groups.
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty is a viable alternative for the management of HSK-related deep stromal opacity. Although posterior corneal folds can be relieved intraoperatively in some of these cases, folds near Descemet membrane should be left in situ because of the high risk of Descemet membrane perforation.
authors.affiliation: *School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China; and †Department of Ophthalmology and Vision Science, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yueping
authors.initials: Y
authors.lastname: Ren
authors.forename: Haiou
authors.initials: H
authors.lastname: Wang
authors.forename: Qinxiang
authors.initials: Q
authors.lastname: Zheng
authors.forename: Pengfei
authors.initials: P
authors.lastname: Tian
authors.forename: Weina
authors.initials: W
authors.lastname: Ren
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000473:pathology; D003318:Corneal Opacity / Q000209:etiology / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D006801:Humans; D016849:Keratitis, Herpetic / Q000150:complications*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity; D055815:Young Adult