Deep Anterior Lamellar Keratoplasty with Melles' technique: Mid-term clinical outcome

PURPOSE: To report the mid-term clinical outcome of deep anterior lamellar keratoplasty (DALK), in a representative group of patients, some of them with low and some of them with high risk allograft rejection (relatively high-risk patient population). METHODS: In 50 eyes of 45 patients, a DALK was performed using the Melles technique. Fifteen eyes were not available for follow-up. Clinical outcome parameters included best-corrected visual acuity, astigmatic error, perforation rate and number of intra- and postoperative complications RESULTS: After contact lens fitting, 19 eyes (83%) reached a BCVA of ≥ 20/40 (≥ 0.5) and 10 eyes (44%) ≥ 20/25 (≥ 0.8). The mean change in refractive spherical equivalent was ‐4.8 ± 5.2 D (range +6.75 to ‐17.0 D) and in refractive astigmatism was 3.8 ± 2.0 D (range 0.0 to 8.0 D). An intraoperative micro-perforation of the host stromal bed occurred in 4/50 eyes (8%). In 12/35 eyes (34%) an epithelial defect persisting for longer than one week was observed. Eight (23%) «high-risk» developed deep stromal or interface vascularization, contact lens induced pannus with suture loosening, diffuse lamellar keratitis, an epithelial rejection line, and/or a recurrence of herpetic interstitial keratitis, all of which were managed by topical steroid treatment and/or systemic antiviral medication. CONCLUSIONS: DALK may be a feasible and relatively safe technique for treatment of relatively complicated anterior corneal pathology. In both low and high risk cases, DALK gives good clinical outcomes, and postoperative complications may be managed easily.