Deep anterior lamellar keratoplasty for pellucid marginal degeneration

To present the surgical outcomes of deep anterior lamellar keratoplasty (DALK) for pellucid marginal degeneration (PMD).

A retrospective review was performed in 16 eyes of 16 patients who underwent DALK at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between January 1, 2006 and December 30, 2009. Baring of Descemet's membrane (DM) during DALK was achieved in 8 (50%) eyes; residual stroma was left intraoperatively in the remaining 8 (50%) eyes. The big bubble technique was performed in 10 (62.5%) eyes and manual dissection was performed in the remaining 6 (37.5%) eyes. Visual acuity (LogMAR notation), intraocular pressure, intraoperative complications and postoperative graft status were assessed.

The mean follow up was 14.6 ± 8.2 months (range 6-35 months). The mean overall age was 31.4 ± 9.6 years (range, 19-50 years). Visual acuity increased statistically significantly from 0.9 ± 0.3 (range 0.5-1.6) preoperatively to 0.4 ± 0.2 (range 0.0-0.7) at last follow-up (p < 0.0001). There was a statistically significant improvement in postoperative sphere, cylinder, and spherical equivalent (p < 0.035, p < 0.001, and p < 0.02, respectively) compared to preoperative. Postoperative visual acuity was not statistically significantly related to gender, type of surgical technique, and baring or perforation of DM. The main graft-related complication was graft-host vascularization (2/16 eyes).

DALK reduces severe corneal astigmatism and results in good visual and refractive outcomes and is an effective alternative for patients with PMD.