Full Text:   <2424>

CLC number: R779.65

On-line Access: 2013-05-04

Received: 2012-10-11

Revision Accepted: 2012-12-20

Crosschecked: 2013-04-15

Cited: 24

Clicked: 5052

Citations:  Bibtex RefMan EndNote GB/T7714

-   Go to

Article info.
1. Reference List
Open peer comments

Journal of Zhejiang University SCIENCE B 2013 Vol.14 No.5 P.438-450


Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Author(s):  Yong-ming Zhang, Shuang-qing Wu, Yu-feng Yao

Affiliation(s):  Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; more

Corresponding email(s):   yaoyuf@mail.hz.zj.cn

Key Words:  Full-bed deep anterior lamellar keratoplasty, Penetrating keratoplasty, Keratoconus, Forceps hooking, Viscoelastic detaching

Share this article to: More <<< Previous Article|

Yong-ming Zhang, Shuang-qing Wu, Yu-feng Yao. Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus[J]. Journal of Zhejiang University Science B, 2013, 14(5): 438-450.

@article{title="Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus",
author="Yong-ming Zhang, Shuang-qing Wu, Yu-feng Yao",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus
%A Yong-ming Zhang
%A Shuang-qing Wu
%A Yu-feng Yao
%J Journal of Zhejiang University SCIENCE B
%V 14
%N 5
%P 438-450
%@ 1673-1581
%D 2013
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1200272

T1 - Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus
A1 - Yong-ming Zhang
A1 - Shuang-qing Wu
A1 - Yu-feng Yao
J0 - Journal of Zhejiang University Science B
VL - 14
IS - 5
SP - 438
EP - 450
%@ 1673-1581
Y1 - 2013
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1200272

Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao’s hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Al-Torbak, A.A., Al-Motowa, S., Al-Assiri, A., Al-Kharashi, S., Al-Shahwan, S., Al-Mezaine, H., Teichmann, K., 2006. Deep anterior lamellar keratoplasty for keratoconus. Cornea, 25(4):408-412.

[2]Amayem, A.F., Anwar, M., 2000. Fluid lamellar keratoplasty in keratoconus. Ophthalmology, 107(1):76-79, discussion 80.

[3]Anwar, H.M., Anwar, M., 2011. Predescemetic dissection for healed hydrops—judicious use of air and fluid. Cornea, 30(12):1502-1509.

[4]Bahar, I., Kaiserman, I., Srinivasan, S., Ya-Ping, J., Slomovic, A.R., Rootman, D.S., 2008. Comparison of three different techniques of corneal transplantation for keratoconus. Am. J. Ophthalmol., 146(6):905-912.

[5]Cheng, Y.Y., Visser, N., Schouten, J.S., Wijdh, R.J., Pels, E., van Cleynenbreugel, H., Eggink, C.A., Zaal, M.J., Rijneveld, W.J., Nuijts, R.M., 2011. Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology, 118(2):302-309.

[6]Chew, A.C., Mehta, J.S., Tan, D.T., 2011. Deep lamellar keratoplasty after resolution of hydrops in keratoconus. Cornea, 30(4):454-459.

[7]Coombes, A.G., Kirwan, J.F., Rostron, C.K., 2001. Deep lamellar keratoplasty with lyophilised tissue in the management of keratoconus. Br. J. Ophthalmol., 85(7):788-791.

[8]Feizi, S., Javadi, M.A., Jamali, H., Mirbabaee, F., 2010. Deep anterior lamellar keratoplasty in patients with keratoconus: big-bubble technique. Cornea, 29(2):177-182.

[9]Fontana, L., Parente, G., Tassinari, G., 2007. Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am. J. Ophthalmol., 143(1):117-124.

[10]Funnell, C.L., Ball, J., Noble, B.A., 2006. Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus. Eye, 20(5):527-532.

[11]Han, D.C., Mehta, J.S., Por, Y.M., Htoon, H.M., Tan, D.T., 2009. Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am. J. Ophthalmol., 148(5):744-751.

[12]Huo, Y.N., Yao, Y.F., Yu, P., 2011. Pathogenic mutations of TGFBI and CHST6 genes in Chinese patients with Avellino, lattice, and macular corneal dystrophies. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 12(9):687-693.

[13]Ing, J.J., Ing, H.H., Nelson, L.R., Hodge, D.O., Bourne, W.M., 1998. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology, 105(10):1855-1865.

[14]Jensen, L.B., Hjortdal, J., Ehlers, N., 2010. Longterm follow-up of penetrating keratoplasty for keratoconus. Acta Ophthalmol., 88(3):347-351.

[15]Jones, M.N., Armitage, W.J., Ayliffe, W., Larkin, D.F., Kaye, S.B., 2009. Penetrating and deep anterior lamellar keratoplasty for keratoconus: a comparison of graft outcomes in the United Kingdom. Invest. Ophthalmol. Vis. Sci., 50(12):5625-5629.

[16]Krachmer, J.H., Feder, R.S., Belin, M.W., 1984. Keratoconus and related noninflammatory corneal thinning disorders. Surv. Ophthalmol., 28(4):293-322.

[17]Kubaloglu, A., Sari, E.S., Unal, M., Koytak, A., Kurnaz, E., Cinar, Y., Ozerturk, Y., 2011. Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus. Am. J. Ophthalmol., 151(5):760-767.

[18]Lim, L., Pesudovs, K., Coster, D.J., 2000. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology, 107(6):1125-1131.

[19]Marchini, G., Mastropasqua, L., Pedrotti, E., Nubile, M., Ciancaglini, M., Sbabo, A., 2006. Deep lamellar keratoplasty by intracorneal dissection: a prospective clinical and confocal microscopic study. Ophthalmology, 113(8):1289-1300.

[20]Muller, L.J., Pels, L., Vrensen, G.F., 1996. Ultrastructural organization of human corneal nerves. Invest. Ophthalmol. Vis. Sci., 37(4):476-488.

[21]Muller, L.J., Marfurt, C.F., Kruse, F., Tervo, T.M., 2003. Corneal nerves: structure, contents and function. Exp. Eye Res., 76(5):521-542.

[22]Patel, D.V., McGhee, C.N., 2009. In vivo confocal microscopy of human corneal nerves in health, in ocular and systemic disease, and following corneal surgery: a review. Br. J. Ophthalmol., 93(7):853-860.

[23]Patel, S.V., Hodge, D.O., Bourne, W.M., 2005. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am. J. Ophthalmol., 139(2):311-319.

[24]Pramanik, S., Musch, D.C., Sutphin, J.E., Farjo, A.A., 2006. Extended long-term outcomes of penetrating keratoplasty for keratoconus. Ophthalmology, 113(9):1633-1638.

[25]Rabinowitz, Y.S., 1998. Keratoconus. Surv. Ophthalmol., 42(4):297-319.

[26]Ramamurthi, S., Ramaesh, K., 2011. Surgical management of healed hydrops: a novel modification of deep anterior lamellar keratoplasty. Cornea, 30(2):180-183.

[27]Sarnicola, V., Toro, P., 2011. Blunt cannula for descemetic deep anterior lamellar keratoplasty. Cornea, 30(8):895-898.

[28]Sarnicola, V., Toro, P., Gentile, D., Hannush, S.B., 2010. Descemetic DALK and predescemetic DALK: outcomes in 236 cases of keratoconus. Cornea, 29(1):53-59.

[29]Sharif, K.W., Casey, T.A., 1991. Penetrating keratoplasty for keratoconus: complications and long-term success. Br. J. Ophthalmol., 75(3):142-146.

[30]Sharma, N., Mannan, R., Jhanji, V., Agarwal, T., Pruthi, A., Titiyal, J.S., Vajpayee, R.B., 2011. Ultrasound biomicroscopy-guided assessment of acute corneal hydrops. Ophthalmology, 118(11):2166-2171.

[31]Sherwin, T., Brookes, N.H., 2004. Morphological changes in keratoconus: pathology or pathogenesis. Clin. Exp. Ophthalmol., 32(2):211-217.

[32]Shimazaki, J., Shimmura, S., Ishioka, M., Tsubota, K., 2002. Randomized clinical trial of deep lamellar keratoplasty vs. penetrating keratoplasty. Am. J. Ophthalmol., 134(2):159-165.

[33]Smiddy, W.E., Hamburg, T.R., Kracher, G.P., Stark, W.J., 1988. Keratoconus. Contact lens or keratoplasty? Ophthalmology, 95(4):487-492.

[34]Sugita, J., Kondo, J., 1997. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement. Br. J. Ophthalmol., 81(3):184-188.

[35]Tuft, S.J., Gregory, W.M., Buckley, R.J., 1994. Acute corneal hydrops in keratoconus. Ophthalmology, 101(10):1738-1744.

[36]van Dooren, B.T., Mulder, P.G., Nieuwendaal, C.P., Beekhuis, W.H., Melles, G.R., 2004. Endothelial cell density after deep anterior lamellar keratoplasty (Melles technique). Am. J. Ophthalmol., 137(3):397-400.

[37]Watson, S.L., Ramsay, A., Dart, J.K., Bunce, C., Craig, E., 2004. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. Ophthalmology, 111(9):1676-1682.

[38]Wu, S.Q., Zhou, P., Zhang, B., Qiu, W.Y., Yao, Y.F., 2012. Long-term comparison of full-bed deep lamellar keratoplasty with penetrating keratoplasty in treating corneal leucoma caused by herpes simplex keratitis. Am. J. Ophthalmol., 153(2):291-299.

[39]Yao, Y.F., 2008. A novel technique for performing full-bed deep lamellar keratoplasty. Cornea, 27(s1):S19-S24.

[40]Yao, Y.F., Zhang, B., Zhou, P., Jiang, J.K., 2002. Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage. Ophthalmology, 109(11):2011-2017.

[41]Yao, Y.F., Jin, Y.Q., Zhang, B., Zhou, P., Zhang, Y.M., Qiu, W.Y., Mou, S.L., Wu, L.Q., 2006. Recurrence of lattice corneal dystrophy caused by incomplete removal of stroma after deep lamellar keratoplasty. Cornea, 25(10 Suppl. 1):S41-S46.

[42]Yeh, S., Smith, J.A., 2008. Management of acute hydrops with perforation in a patient with keratoconus and cone dystrophy: case report and literature review. Cornea, 27(9):1062-1065.

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - Journal of Zhejiang University-SCIENCE