Comparison Of Clinical Outcome And Complications Post Full Bed Deep Lamellar Keratoplasty In Keratoconus VS Herpetic Corneal Opacity

Objective: To compare the clinical outcomes and complications after Full-bed Deep Lamellar Keratoplasty (FB-DLK) in keratoconus and herpetic corneal opacity.Materials and methods: Retrospective case study. We reviewed the clinical notes of 27 eyes of 26 patients who had herpetic corneal opacity and 18 eyes of 16 patients who had keratoconus. In both groups FB-DLK was performed with the technique described by Dr. Yao in SRRSH hospital from Jan.2003 to Mar.2007. The procedure of operations, best corrected visual acuity (BCVA) and complications were analyzed.Results: The 27 eyes of 26 patients who had herpetic corneal opacity as the HSK group had a mean age of 46.4 years and a median follow-up of 18.0 months. The mean age of the 16 patients (18 eyes) who had keratoconus as the keratoconus group was 21.1 years and had a median follow-up of 18.8 months. The patients in the two groups were matched for preoperative best corrected visual acuity, gender and follow-up period. The median donor diameter of HSK group was 7.75mm, which is significantly larger compared with 7.5mm in keratoconus group (Wilcoxon Mann-Whitney test, P<0.05) while the median bed size in both groups was 7.5mm. Although microperforation of Descemet's membrane occurred in 6 eyes (22.2%) in HSK group and 5 eyes (27.8%) in keratoconus group, all of the operations were successfully completed. The median final BCVA was 0.3 in HSK group, which is significantly lower compared with 0.6 in keratoconus group (Wilcoxon Mann-Whitney test, P<0.05). The rates of postoperative pseudo-anterior chamber, ocular hypertension and secondary glaucoma in HSK group was 33.3%(9 eyes), 7.4%(2 eyes) and 7.4%(2 eyes) respectively, while the keratoconus group had no postoperative complications at all. The rate of postoperative pseudo-anterior chamber is significantly higher in HSK group than in keratoconus group.Conclusions: The median final BCVA and improvement of visual acuity was significantly better in keratoconus group than in HSK group. There was less risk for postoperative complications in keratoconus group than in HSK group. We should pay more attention in HSK patients who underwent FB-DLK to prevent postoperative complications.