Penetrating keratoplasty versus deep anterior lamellar kerat
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A retrospective comparative interventional case series study included consecutive pediatric keratoconus cases (18 years of age) who received PK (n=45) or DALK (n=54) in two different time periods. Postoperative best spectacle-corrected visual acuity (BSCVA), refraction, and complications were compared between the study groups.

The mean follow-up was 83.3±46.1 and 63.3±45.6 months in the PK and DALK groups, respectively (P=0.10). Postoperatively, BSCVA was 0.20±0.19 logMAR in the PK group and 0.26±0.19 logMAR in the DALK group (P=0.11), with a BSCVA of 20/40 in 91.1% and 83.3% of eyes, respectively (P=0.25). Two groups were comparable regarding postoperative refractive outcomes. Graft epitheliopathy and suture-associated complications were more commonly encountered after DALK, which was attributable to the effect of low-quality grafts on the clinical outcomes of DALK. Ten PK eyes (22.2%) and nine DALK eyes (16.7%) experienced at least one episode of graft rejection within 5 years of corneal transplantation (P=0.49). Rejection was reversible in 93.1% and 100% of episodes in the PK and DALK groups, respectively (P=0.63). At the postoperative year 5, 95.6% of grafts in the PK group and 98.2% in the DALK group remained clear (P=0.45).

No significant difference was observed in the outcomes between PK and DALK in pediatric keratoconus. Low-quality donor tissues in DALK increased the incidence of graft epithelial problems and suture-related complications as compared to PK.

Read more : https://www.sciencedirect.com/science/article/abs/pii/S0002939421000301?dgcid=rss_sd_all
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