Deep Anterior Lamellar Keratoplasty. Experiences and results of the first 100 consecutive DALK from the University Eye Hospital of Cologne

Deep anterior lamellar keratoplasty (DALK) is a treatment option for patients with diseases of the corneal stroma without endothelial involvement and has been used at the Department of Ophthalmology of the University of Cologne since July 2011. Experiences and results of the first 100 consecutive cases from Cologne with a minimum follow-up of 1 year are summarized. We included the first 100 consecutive DALKs. Indications for anterior lamellar keratoplasty, the feasibility of the surgery, the postoperative course, in addition to the complications and clinical outcome 3 months after complete suture removal, were examined. The rate of conversion to penetrating keratoplasty in all planned DALKs during the observation period was also recorded. Mean follow-up was 25.6 +/- 13 months. In 99 eyes of 97 patients (72 men, 25 women; aged 43.5 +/- 16.9 years), the first 100 DALKs were performed in the period between 26 July 2011 and 27 January 2015 (87 cases electively, 13 cases as DALK A chaud, 1 of which was a second DALK). The most common indications were keratoconus (68%), corneal ulcers (13%), and corneal scarring (13%). On average, visual acuity increased from 0.83 +/- 0.4 to 0.09 +/- 0.1 logMAR. In 6 eyes (6%) grafts could not be preserved because of a corneal ulcer (n = 5, n = 3 of which were recurrent episodes), and in 1 case because of postoperative bulbus trauma. Rate of conversion to penetrating keratoplasty during the observation period was 11.5%. In eyes with keratoconus, visual acuity increased from 0.89 +/- 0.4 before DALK to 0.06 +/- 0.1 logMAR (best-corrected with contact lens) and the conversion rate was 17.6%. DALK represents a reliable technique for corneal transplantation in different pathological conditions of the cornea and the risk of endothelial immune responses can be avoided completely. In keratoconus and corneal scarring in particular, DALK can be used as a safe treatment option with very good results