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Outcomes of large-diameter deep anterior lamellar keratoplasty and converted two-piece mushroom penetrating keratoplasty for herpetic corneal scars

Eye volume 38, pages 614–619 (2024)Cite this article

Subjects

Abstract

Purpose

To report the clinical outcomes of large diameter deep anterior lamellar keratoplasty (DALK) and converted two-piece microkeratome-assisted mushroom keratoplasty (MK) for herpetic corneal scars.

Methods

In this single-centre study, large diameter (9 mm) DALK was attempted in consecutive patients with herpetic corneal scars. In case of macroperforation or unsatisfactory clearance of the optical zone, the procedure was intraoperatively converted to two-piece microkeratome-assisted MK. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, endothelial cell density (ECD), immunologic rejection, herpetic recurrence and graft failure rates in the two groups.

Results

DALK was successfully performed in 98 of 120 eyes, while the remaining 22 eyes required intraoperative conversion to MK. At 5 years, mean logMAR BSCVA was 0.10 ± 0.12 in the DALK group and 0.09 ± 0.15 in the MK group (P = 0.75). Refractive astigmatism at 5 years was 2.8 ± 1.4 D in the DALK group and 3.0 ± 1.7 D in the MK group (P = 0.67). ECD was higher in the DALK group than in the MK group at all time points (P < 0.001), with a mean annual cell loss of 10.9% after MK and 4.2% after DALK. The 5-year risk for immunologic rejection (DALK: 3%, MK: 5%, P = 0.38), herpetic recurrence (DALK: 6%, MK: 9%, P = 0.38), and graft failure (DALK: 4%, MK: 5%, P = 0.75) were comparable in both groups.

Conclusion

Large diameter (9 mm) DALK yields excellent visual and clinical outcomes in eyes with herpetic corneal scars. In case of intraoperative complications, DALK can be converted to two-piece microkeratome-assisted MK to maximize the refractive benefit of a large diameter graft while minimizing the risk of endothelial failure.

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Fig. 1: Clinical photos.

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Data availability

The dataset used and analysed during the current study is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. University of Ferrara, Department of Translational Medicine, Ferrara, Italy

    Marco Pellegrini, Angeli Christy Yu, Rossella Spena, Cristina Bovone & Massimo Busin

  2. Ospedali Privati Forlì “Villa Igea”, Department of Ophthalmology, Forlì, Italy

    Marco Pellegrini, Angeli Christy Yu, Rossella Spena, Cristina Bovone & Massimo Busin

  3. Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy

    Marco Pellegrini, Angeli Christy Yu, Rossella Spena, Cristina Bovone & Massimo Busin

  4. Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

    Giorgio Zauli

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  1. Marco Pellegrini
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Contributions

Conceptualization, MP, ACY and MB; methodology, MP, ACY, RS, CB, GZ and MB; investigation, MP, ACY and MB; writing—original draft preparation, MP, ACY and RS; writing—review and editing, CB, GZ and MB.

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Correspondence to Massimo Busin.

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Pellegrini, M., Yu, A.C., Spena, R. et al. Outcomes of large-diameter deep anterior lamellar keratoplasty and converted two-piece mushroom penetrating keratoplasty for herpetic corneal scars. Eye 38, 614–619 (2024). https://doi.org/10.1038/s41433-023-02744-0

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