Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi University, Turkey
Approval Date: 2015
Thesis Language: Turkish
Student: Dr. KÜBRA SERBEST CEYLANOĞLU
Supervisor: BAHRİ AYDIN
Abstract:PURPOSE: To compare and evaluate the clinical outcomes of deep anterior lamellar keratoplasty (DALK) and excimer laser assisted anterior lamellar keratoplasty (ELALK) in eyes with keratoconus. MATERIAL AND METHOD: Thirty five keratoconic eyes of 35 patients who underwent DALK surgery were included. In 4 eyes, the procedure was converted to penetrating keratoplasty because of Descemet s membrane (DM) macroperforations, they weren t enrolled. Twenty five keratoconic eyes of 26 patients who underwent ELALK surgery were included. Preoperatively and at control visits complete ophthalmic examination was performed including uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), refraction, keratometric readings and biomicroscopy. Also all surgical complications were recorded. RESULTS The mean patient age at the time of DALK surgery 27 years and mean follow-up period was ± 6.3 (range 6-26) months. Preoperative and postoperative BSCVA was 0.04 ± 0.4 (range 0.016-0.2) and 0.62 ± 0.23 (range 0.2-1.0), respectively. Preoperative mean keratometric value was 62.53 ± 12.69 D, decreasing to 41.53 ± 8.57 at final follow-up examination. Descemet membrane macroperforation was occured in 4 eyes and converted to penetrating keratoplasty. Descemet membrane microperforation was occured in 7 patient. The mean patient age at the time of ELALK surgery 27 years and mean follow-up period was 44 ± 18 (range 19-78). Preoperative and postoperative BSCVA was 0.11 ± 0.12 (range 0.016-0.4) and 0.32 ± 0.2 (range 0.1-0.8), respectively. Preoperative and postoperative final visit mean keratometric value was 60.08 ± 8.88 D and 45.99 ± 6.14 D. Microperforation was occured in 1 patient. In 4 eyes, interface irregularity was developed. None of the patient in fllow-up had graft rejection. CONCLUSION Penetrating keratoplasty has been the first choice for surgical treatment of keratoconus for many years. However, endothelial graft rejection after penetrating keratoplasty, long-term steroid-induced cataracts and secondary complications such as glaucoma development affecting graft survival have led to new treatment seeking. Higher visual acuity in DALK group was statistically significant (p<0.05). It has been put forward that, the lack of visual acuity in ELALK group is due to not achieving a smooth interface as in DALK group.