DALK provides high rate of long-term graft survival

April 23, 2012

Ten-year experience with deep anterior lamellar keratoplasty, a procedure in which healthy endothelium is transplanted to treat anterior-stromal corneal disorders, is that the graft survival rate is more than 99%, according to Vincenzo Sarnicola, MD.

Chicago-Ten-year experience with deep anterior lamellar keratoplasty (DALK), a procedure in which healthy endothelium is transplanted to treat anterior-stromal corneal disorders, is that the graft survival rate is more than 99%, according to Vincenzo Sarnicola, MD.

The visual acuity levels are comparable to those achieved with penetrating keratoplasty (PKP), and the associated rate of endothelial cell loss is low, said Dr. Sarnicola, of the Department of Ophthalmology, Misericordia Hospital, Grosseto, Italy.

He presented the results of a retrospective, consecutive, non-comparative case series. A total of 660 eyes of 502 patients were followed for an average of 54.6 months. The vast majority of cases (75%) underwent DALK to treat keratoconus. He noted the results based on the outcomes of 120 eyes.

“The results in these eyes were comparable to PKP and the visual acuity was at least 20/25 in about 85% of the cases,” Dr. Sarnicola said.

The endothelial cell loss was low, about 10%, and occurred during the first 6 months postoperatively and then stabilized.

The rejection rate was also very low, 4%. Dr. Sarnicola identified two types of rejection, early cellular infiltrates in the epithelium and later subepithelial infiltrates in the donor tissue.

The cases where the procedure failed did so in the first 2 years postoperatively; failure was related to poor ocular surface defenses, Dr. Sarnicola said.

“The survival rate was more than 99% with a follow-up of 54.6 months,” he said. The failures were due to a Pseudomonas infection, a corneal ulcer, poor surgical procedures, and a case of herpes infection in the donor tissue.

DALK is a successful transplantation procedure with high long-term graft survival rates and stable endothelial cell density after the first 6 months postoperative. The DALK survival rate does not vary significantly over time, Dr. Sarnicola concluded.

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