Indications and clinical outcome of Deep Anterior Lamellar Keratoplasty (DALK ) in central India

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Indications and clinical outcome of Deep Anterior Lamellar Keratoplasty (DALK ) in central India

Journal Title: Journal of Indira Gandhi Institute of Medical Sciences - Year 2018, Vol 4, Issue 2

Abstract

In a developing country like India where blindness due to corneal diseases is on a rising tide, lamellar keratoplasty has proved to be a boon. Twenty first century is an era of custom keratoplasty. It aims at selectively treating only the diseased portions of cornea. A wide deficit exists between corneal demand and supply. In this regard lamellar keratoplasty have gained an edge. A single good quality cornea can be used in three patients, lamellar grafts up to posterior stroma can be used for DALK (Deep Anterior Lamellar Keratoplasty), Descemet’s with endothelium can be used for DSEK (Descemet’s Stripping Endothelial Keratoplasty), cornea scleral rim can be used for limbal stem cell deficiency (LSCD) .Among lamellar keratoplasty DALK has an edge over penetrating keratoplasty.{2} DALK eliminates the risk of endothelial rejection by selectively replacing the pathological corneal layer while preserving the healthy endothelium.{1} The requirements for DALK are a healthy recipient ocular surface, an adequate endothelial cell function, a corneal opacity that spares DM and a grossly distorted corneal surface that precludes contact lens fit. DALK offers an edge as corneas with low endothelial counts can be used. {2} Inferior quality corneas can be used in DALK with good results. DALK can be done in corneas of varied opacities like keratoconus stromal dystrophies and corneal scars. The extraocular nature of this procedure and a greater wound strength are added advantages of DALK. {2} This study was done with the view of reporting clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with varied corneal opacities. MATERIALS AND METHOD Retrospective review of clinical records of 54 eye of 54 patients of DALK was done. Cases included were corneal opacities of varied causes. Study location was Department of cornea Sadguru Netra Chikitsalaya Chitrakoot, India. Exclusion criteria was patients with incomplete documentation, follow up of less than 3 months and other ocular co-morbidities like patients with any posterior segment pathologies, secondary glaucoma and derangements of anterior segment were excluded from the study. The Statistical analysis was performed by STATA 11.2 (College Station TX USA). Shapiro Wilk test were used to find normality. Wilcoxon sign rank test were used to find the pre and post significance difference between the Log Mar uncorrected visual acuity. P<0.05 was considered as statistically significance. Data collected included patients age at operation, indication for operation, pre and post-operative keratometry, pre and post-operative Best corrected visual acuity (BCVA), astigmatism, length of follow up and complications. Slit lamp examination for signs of graft rejection, inflammation, uveitis, neovascularisation; wound integrity, graft haze or interface haze, intraocular pressure by NCT, suture removal and graft clarity. © Indira Gandhi Institute of Medical Sciences

Authors and Affiliations

Dr. Seema Kumari

Keywords

Deep anterior lamellar keratoplasty gra rejecon.

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EP ID EP546327
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