Effects of deep lamellar keratoplasty on severe necrotizing stromal keratitis

Objective: This study is to investigate the application of deep lamellar keratoplasty (DLKP) in the treatment of necrotizing stromal keratitis (NSK). Methods: Corneal confocal microscopy and histopathological examination were performed before surgery. DLKP and penetrating keratoplasty (PKP) were performed on 14 and 20 NSK subjects, respectively, followed by proper drug administration. In the follow-up period, the pathological features were evaluated and compared. Results: Significant corneal neovascularization and inflammatory cell infiltration were observed in NSK patients before surgery. After proper drug treatments, PKP and DLKP were performed. In the followup period, the visual acuity was elevated in the PKP and DLKP groups at 1 y after surgery. Moreover, corneal opacity was observed in 2 corneal grafts in the PKP group, while all the corneal grafts were transparent in the DLKP group. Furthermore, compared with the PKP group, corneal endothelial cell numbers at 6 and 12 months after surgery were significantly higher in the DLKP group. On the other hand, there were 2 eyes reporting virus recurrence in the PKP group, while no virus recurrence was reported in the DLKP group. Moreover, 4 eyes were accompanied with neovascularization at the corneal graft edge in the PKP group, while there was only 1 eye associated with neovascularization in the DLKP group. Furthermore, 5 cases in the PKP group reported graft rejection, while no rejection case was reported for DLKP. Conclusion: DLKP provides superior outcomes to PKP in treating NSK, which might be an ideal alternative option for the disease treatment.