How Much Progress Has Been Made in Corneal Transplantation?

Area of Science:

• Ophthalmology
• Corneal Surgery
• Transplantation Immunology

Background:

• Corneal diseases like keratoconus and bullous keratopathy necessitate transplantation.
• Penetrating keratoplasty (PKP) is a traditional method, but lamellar techniques offer potential advantages.
• Assessing component lamellar keratoplasty outcomes is crucial for surgical decision-making.

Purpose of the Study:

• To compare the surgical outcomes of deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK) with penetrating keratoplasty (PKP).
• To evaluate graft clarity, visual acuity, endothelial cell density (ECD), and complications for keratoconus and laser iridotomy-induced bullous keratopathy (LI-BK).

Main Methods:

• Retrospective analysis of 79 eyes with keratoconus treated with DALK and 81 eyes with LI-BK treated with DSAEK.
• Comparison with 273 eyes with keratoconus and 98 eyes with LI-BK treated with PKP.
• Assessment of graft survival, best spectacle-corrected visual acuity, ECD, and surgical complications at various time points.

Main Results:

• DALK and PKP showed excellent visual outcomes for keratoconus, with PKP having higher graft survival (P < 0.0001).
• DSAEK demonstrated better visual acuity for LI-BK, though with a higher ECD decrease compared to PKP.
• PKP had increased immunological rejection and secondary glaucoma incidence versus DALK; Descemet membrane microperforation occurred in 49 DALK eyes.

Conclusions:

• DALK and DSAEK significantly improve surgical outcomes for keratoconus and LI-BK, respectively.
• Further research is needed to refine DALK surgical safety and mitigate early ECD loss in DSAEK.
• Lamellar keratoplasty techniques offer viable alternatives to PKP, with specific benefits and areas for development.