Deep Anterior Lamellar Keratoplasty Improves Visual Outcomes
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A Study was conducted to describe a series of patients who underwent deep anterior lamellar keratoplasty (DALK) after previous anterior lamellar keratoplasty (ALK) to improve their visual outcomes.

This is a case study of 9 DALK eyes (9 patients) who had previously undergone ALK and had an unsatisfactory visual outcome. Surgery was carried out in all cases at least three years after the ALK diagnosis. Techniques such as cannula large bubble, air viscobubble, and manual dissection were used. The best-corrected visual acuity, residual recipient bed thickness, and endothelial cell count were measured before and after surgery. Both eyes were followed for at least 24 months.

Results:
--2 subtotal anterior lamellar keratoplasties (through 1 type 1 big bubble and 1 air viscobubble) and 7 manual dissection DALKs were achieved.

--A small rupture of the residual recipient bed occurred during 1 case, and it was managed without penetrating keratoplasty conversion. Mean best-corrected visual acuity improved from 0.64 to 0.09 logMAR.

--Postoperative residual recipient central bed thickness was less than 80 microm in all cases.

--No postoperative complications were recorded at the last follow-up (24–36 months postoperatively).

To summarize, various DALK strategies can be used effectively to increase visual acuity in previous ALK eyes with poor visual outcomes.

Source: https://journals.lww.com/corneajrnl/Abstract/2021/05000/Deep_Anterior_Lamellar_Keratoplasty_After_Previous.11.aspx
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