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Outcomes of therapeutic deep lamellar keratoplasty and penetrating keratoplasty for advanced infectious keratitis: a comparative study.
Ophthalmology 2009; 116(4):615-23O

Abstract

PURPOSE

To compare the therapeutic success, visual outcomes, complications, and graft survival rates of therapeutic deep anterior lamellar keratoplasty (TDALK) and therapeutic penetrating keratoplasty (TPK) for advanced infectious keratitis.

DESIGN

Retrospective, comparative study.

PARTICIPANTS

One hundred twenty-three patients (126 eyes) with medically uncontrolled infectious keratitis of bacterial, fungal, or acanthamoeba etiologies who underwent TDALK (n = 26) or TPK (n = 100 eyes; 80 nonperforated ulcers; 20 perforated ulcers; mean follow-up in TDALK, 12.9 months; in TPK, 21.3 months).

METHODS

We performed TDALK for infections confined to the corneal stroma and the technique used was either manual lamellar dissection or Anwar's big bubble technique for total stromal removal. Therapeutic penetrating keratoplasty was performed for either nonperforated or perforated ulcers. Comparison with respect to recurrence of infection, visual acuity, graft survival, and complications was made. Baseline characteristics of the patients were analyzed using the chi-square test. Kaplan-Meier survival analysis was used to evaluate graft survival.

MAIN OUTCOMES MEASURES

Therapeutic success (eradication of infection) or therapeutic failure (recurrence of original infection in cornea or sclera, or as endophthalmitis), graft survival (clarity), and best-corrected visual acuity (BCVA).

RESULTS

Therapeutic success rate of 84.6% was achieved in the TDALK group and 88% in the TPK group (P = 0.74); of the 12 eyes with recurrence of infection in the TPK cohort, 6 developed endophthalmitis with poor outcomes. A BCVA of > or =6/9 was achieved in 50% of patients in the TDALK group and 20.2% in the TPK group (P = 0.01). Mean improvement of acuity was 7.27 lines in the TDALK group and 4.76 lines in the TPK group (P = 0.01). Kaplan-Meier survival analysis at 1 year showed better graft survival for TDALK (90%) compared with TPK (78.4%).

CONCLUSIONS

For medically unresponsive infectious keratitis, TDALK may be considered instead of TPK yielding similar graft survival, without an increased risk of disease recurrence.

Authors+Show Affiliations

Singapore National Eye Centre, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19243833

Citation

Anshu, Arundhati, et al. "Outcomes of Therapeutic Deep Lamellar Keratoplasty and Penetrating Keratoplasty for Advanced Infectious Keratitis: a Comparative Study." Ophthalmology, vol. 116, no. 4, 2009, pp. 615-23.
Anshu A, Parthasarathy A, Mehta JS, et al. Outcomes of therapeutic deep lamellar keratoplasty and penetrating keratoplasty for advanced infectious keratitis: a comparative study. Ophthalmology. 2009;116(4):615-23.
Anshu, A., Parthasarathy, A., Mehta, J. S., Htoon, H. M., & Tan, D. T. (2009). Outcomes of therapeutic deep lamellar keratoplasty and penetrating keratoplasty for advanced infectious keratitis: a comparative study. Ophthalmology, 116(4), pp. 615-23. doi:10.1016/j.ophtha.2008.12.043.
Anshu A, et al. Outcomes of Therapeutic Deep Lamellar Keratoplasty and Penetrating Keratoplasty for Advanced Infectious Keratitis: a Comparative Study. Ophthalmology. 2009;116(4):615-23. PubMed PMID: 19243833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of therapeutic deep lamellar keratoplasty and penetrating keratoplasty for advanced infectious keratitis: a comparative study. AU - Anshu,Arundhati, AU - Parthasarathy,Anand, AU - Mehta,Jodhbir S, AU - Htoon,Hla Myint, AU - Tan,Donald T H, Y1 - 2009/02/25/ PY - 2008/06/28/received PY - 2008/12/16/revised PY - 2008/12/17/accepted PY - 2009/2/27/entrez PY - 2009/2/27/pubmed PY - 2009/4/25/medline SP - 615 EP - 23 JF - Ophthalmology JO - Ophthalmology VL - 116 IS - 4 N2 - PURPOSE: To compare the therapeutic success, visual outcomes, complications, and graft survival rates of therapeutic deep anterior lamellar keratoplasty (TDALK) and therapeutic penetrating keratoplasty (TPK) for advanced infectious keratitis. DESIGN: Retrospective, comparative study. PARTICIPANTS: One hundred twenty-three patients (126 eyes) with medically uncontrolled infectious keratitis of bacterial, fungal, or acanthamoeba etiologies who underwent TDALK (n = 26) or TPK (n = 100 eyes; 80 nonperforated ulcers; 20 perforated ulcers; mean follow-up in TDALK, 12.9 months; in TPK, 21.3 months). METHODS: We performed TDALK for infections confined to the corneal stroma and the technique used was either manual lamellar dissection or Anwar's big bubble technique for total stromal removal. Therapeutic penetrating keratoplasty was performed for either nonperforated or perforated ulcers. Comparison with respect to recurrence of infection, visual acuity, graft survival, and complications was made. Baseline characteristics of the patients were analyzed using the chi-square test. Kaplan-Meier survival analysis was used to evaluate graft survival. MAIN OUTCOMES MEASURES: Therapeutic success (eradication of infection) or therapeutic failure (recurrence of original infection in cornea or sclera, or as endophthalmitis), graft survival (clarity), and best-corrected visual acuity (BCVA). RESULTS: Therapeutic success rate of 84.6% was achieved in the TDALK group and 88% in the TPK group (P = 0.74); of the 12 eyes with recurrence of infection in the TPK cohort, 6 developed endophthalmitis with poor outcomes. A BCVA of > or =6/9 was achieved in 50% of patients in the TDALK group and 20.2% in the TPK group (P = 0.01). Mean improvement of acuity was 7.27 lines in the TDALK group and 4.76 lines in the TPK group (P = 0.01). Kaplan-Meier survival analysis at 1 year showed better graft survival for TDALK (90%) compared with TPK (78.4%). CONCLUSIONS: For medically unresponsive infectious keratitis, TDALK may be considered instead of TPK yielding similar graft survival, without an increased risk of disease recurrence. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19243833/Outcomes_of_therapeutic_deep_lamellar_keratoplasty_and_penetrating_keratoplasty_for_advanced_infectious_keratitis:_a_comparative_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(08)01343-2 DB - PRIME DP - Unbound Medicine ER -