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|Title:||Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty||Authors:||Fuest, Matthias
Siregar, Sharita R.
Htoon, Hla Myint
Mehta, Jodhbir S.
|Keywords:||Engineering::Materials||Issue Date:||2018||Source:||Fuest, M., Siregar, S. R., Farrag, A., Htoon, H. M., Tan, D., & Mehta, J. S. (2018). Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty. Graefe's Archive for Clinical and Experimental Ophthalmology, 256(9), 1669-1677. doi:10.1007/s00417-018-3997-6||Journal:||Graefe's Archive for Clinical and Experimental Ophthalmology||Abstract:||Aims: To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of infection and residual stromal opacity. Methods: Ten eyes of nine consecutive patients undergoing DALK after DSAEK at a single tertiary referral center (SNEC) from 2011 to 2016 were analyzed for best spectacle-corrected visual acuity (BSCVA), refraction, spherical equivalent (SE) and cylinder, as well as graft diameters, survival, and complications. Results: The mean pre-DSAEK BSCVA was 1.73 ± 0.76 LogMAR. At a mean follow-up of 9.8 ± 7.1 months, visual acuity had improved significantly (p = 0.028) to 1.09 ± 0.55 LogMAR after DSAEK. DALK was performed at 10.3 ± 7.2 months after DSAEK because of residual stromal scarring in nine and a corneal infection in one case. At the last follow-up visit (19.4 ± 13.9 months) after DALK, BSCVA had improved to 0.38 ± 0.6 LogMAR, significantly better than after DSAEK alone (p = 0.015) and before DSAEK (p = 0.018). Spherical equivalent (− 4.8 ± 3.5 D) and cylinder (− 2.5 ± 2.0 D) did not show significant changes compared to after DSAEK (SE p = 0.17; cylinder p = 0.19) or 3 months after DALK (SE p = 0.17; cylinder p = 0.46). One endothelial graft failed 3 months after DALK. Kaplan-Meier estimated average survival for all cases was 45.3 (95% CI 36.6–54.0) months. The cumulative survival probability for the entire cohort was 90% at 1, 2, and 4 years of follow-up. Conclusions: DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.||URI:||https://hdl.handle.net/10356/141891||ISSN:||0721-832X||DOI:||10.1007/s00417-018-3997-6||Rights:||© 2018 Springer-Verlag GmbH Germany, part of Springer Nature. All rights reserved.||Fulltext Permission:||none||Fulltext Availability:||No Fulltext|
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