Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions

Purpose. To compare the effectiveness of deep lamellar keratoplasty (DLK) w ith that of penetrating keratoplasty (PKP) in cases of corneal lesions not involving the endothelium. Methods. Forty-eight eyes with leukomatous corne al opacity (n = 33), keratoconus with apical scarring (n = 6), granular cor neal dystrophy (n = 5), lattice corneal dystrophy (n = 2), and multiple cor neal foreign bodies (n = 2) in an age group varying from 16 to 53 years und erwent DLK (n = 24) and PKP (n = 24) by utilizing B and (B+ and A) grade M- K preserved donor tissue, respectively. The patients were followed up close ly, and the graft clarity, visual achievement, astigmatism and endothelial cell count were evaluated at repeated occasions up to 1 year. Results. Asti gmatism of <3 diopters (D) and greater than or equal to 5D was obtained in 19 eyes and one eye, respectively, after DLK at 6 months. whereas six eyes of the PKP group had astigmatism <3D, and 12 eyes had greater than or equal to 5D at the end of 6 months. The same at 1 year was observed in 20 and on e eye in the DLK and eight and five eyes of the PKP group. Astigmatism of g reater than or equal to 5D at the end of 6 months in both the groups showed highly significant changes (p < 0.001). Best corrected visual acuity of 6/ 18 or more was achieved in Is and 12 eyes at 6 months after DLK and PKP, re spectively, which were statistically highly significant (p < 0.001), wherea s at 1 year, it was seen in 17 and 15 eyes of the DLK and PKP groups, respe ctively, which was nonsignificant. The mean endothelial cell count was 2,23 3.3 +/- 64.453 cells/mm(2) and 2,219.6 +/- 102.48 cells/mm(2) at 6 months a nd 1 year, respectively, after DLK, which was nonsignificant. The mean cell count of the donor eyes used for PKP was 2,191 +/- 52.164 cells/min(2), 1, 902.8 +/- 70.346 cells/mm(2) at 6 months, and 1,579.0 +/- 80.24 cells/mm(2) at 1 year. All the values showed highly significant changes (p < 0.001). F urther, the graft clarity of greater than or equal to 3+ was achieved in 20 and 18 eyes at 6 months postoperatively in the DLK and PKP groups, whereas the same was observed in 19 and 13 eyes of both the groups, respectively, at 1-year follow-up. Conclusion. DLK is a promising procedure and should be practiced more frequently for corneal pathology not involving the endothel ium.