Development of visual acuity and refraction in deep lamellar and penetrating keratoplasty (KPL)

Deep lamellar KPL can be considered as an alternative for penetrating KPL in pathologies of corneal stroma, because there is no risk of decompensation of the endothelium or corneal rejection. Nevertheless, it is well know in lamellar keratoplasty that scars may occur in the interface which can limit the final visual acuity. In a retrospective study we compared the postoperative development of visual acuity and refractive values in deep lamellar keratoplasty with a penetrating procedure. 16 consecutive patients (mean age 48 years) with corneal stroma pathologies such as corneal ulcer, alkali burn and keratoconus underwent deep lamellar KPL. The control group consisted of 38 patients (mean age 42 years) with keratoconus who received a penetrating keratoplasty. Visual acuity and subjective spherical and cylindrical values of the refraction were evaluated preoperatively and after 6 weeks, 6 months and 1 year. The mean postoperative visual acuity (VA), spherical (SV) and cylindrical (CV) values of the deep lamellar group (results of the control group in brackets) were at 6 weeks VA = 0.24 +/- 0.24 (0.37 +/- 0.23), SV = 0.325 +/- 5.3 dpt, CV = - 1.66 +/- 0.67 dpt (- 3.08 +/- 1.93 dpt), after 6 months VA = 0.38 +/- 0.28 (0.53 +/- 0.31), SV = - 3.0 +/- 4.42 dpt (0.33 +/- 1.93 dpt), CV = - 2.57 +/- 2.03 dpt (- 2.35 +/- 1.32 dpt) and after 1 year VA = 0.41 +/- 0.27 (0.57 +/- 0.26), SV = - 2.57 +/- 4.62 dpt (0.17 +/- 3.98 dpt), CV = - 2.75 +/- 1.25 dpt (- 0.34 +/- 1.86 dpt). There was no significant difference in all the parameters between the two groups. As the good functional results of deep lamellar KPL are comparable to those of penetration KPL and the risk of endothelial decompensation or rejection is lower in a lamellar procedure, we suggest the use of a deep lamellar KPL in patients with an intact endothelium.