Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty in Pediatric Keratoconus: A 15-Year Retrospective Analysis
Related Experiment Video
Updated: May 5, 2026
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Revathi Rajaraman1, Venugopal Anitha2, Arjun Velayudhan2
1Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
Insights
Deep Anterior Lamellar Keratoplasty (DALK) is a safe and effective treatment for pediatric keratoconus (KC), significantly improving vision and refractive outcomes. The procedure demonstrates excellent long-term graft survival rates in young patients.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Pediatric keratoconus (KC) requires effective long-term management strategies.
- Deep Anterior Lamellar Keratoplasty (DALK) is an alternative to penetrating keratoplasty for KC.
- Evaluating DALK outcomes in pediatric populations is crucial for surgical decision-making.
Purpose of the Study:
- To assess the long-term visual and functional results of DALK in children with KC.
- To identify and analyze complications associated with DALK in pediatric patients.
- To evaluate the refractive outcomes and graft survival after DALK for pediatric KC.
Main Methods:
- Retrospective analysis of 348 eyes from 303 pediatric patients (≤18 years) undergoing DALK for KC.
- Data collected included preoperative and postoperative visual acuity, refraction, and surgical technique (primarily big bubble technique).
- Complications, epithelial healing time, and graft survival were meticulously recorded and analyzed.
Main Results:
- Significant improvements in uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were observed post-DALK.
- Refractive outcomes showed substantial reduction in spherical and astigmatic errors.
- While complications like graft vascularization and infection occurred, long-term graft survival was excellent.
Conclusions:
- DALK is a safe and effective surgical option for pediatric keratoconus.
- The procedure leads to significant visual rehabilitation and refractive correction in children.
- DALK offers favorable long-term outcomes and graft survival in the pediatric population.
Purpose:
To evaluate the long-term visual, functional outcomes, and complications associated with Deep Anterior Lamellar Keratoplasty (DALK) in pediatric keratoconus (KC).
Methods:
A retrospective analysis of children aged ≤18 years who underwent DALK for KC between February 2006 and April 2021. Data on preoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, surgical technique, and complications. The big bubble technique was preferred, with manual or hydrodissection used when necessary. Outcome measures included postoperative UCVA, BCVA, manifest refraction, epithelial healing time, and complications.
Results:
A total of 348 eyes from 303 children (mean age of 14.62 ± 2.59 years) were analyzed. Preoperative corneal scarring was observed in 24.4%, and 27.9% had vernal keratoconjunctivitis. Big bubble technique was successful in 69.8% of eyes. Descemet membrane microperforation occurred in 38 cases (10.9%), and intracameral air tamponade was required in 29 eyes (48.3%). The mean epithelial healing time was 5.00 ± 6.09 days. Postoperatively, mean spherical correction improved from -8.43 ± 5.52D to -2.42 ± 2.60D, and mean refractive astigmatism from -4.65 ± 1.62D to -2.60 ± 1.87D. The UCVA improved from 1.26 ± 0.27 to 0.76 ± 0.32 Log MAR and BCVA from 0.64 ± 0.31 to 0.18 ± 0.17 Log MAR. Complications included graft vascularization in 14.7%, graft infections 6.9%, and glaucoma in 26.7.
Conclusions:
DALK is a safe and effective procedure for managing pediatric KC, offering significant improvements in visual outcomes and refractive parameters with excellent graft survival rates over the long term.
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