Deep Anterior Lamellar Keratoplasty in Children

PURPOSE: To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children. DESIGN: Retrospective interventional case series. METHODS: SETTING: Institutional, L.V. Prasad Eye Institute, a tertiary care center in south India. STUDY POPULATION AND INTERVENTION: All children less than 16 years of age undergoing DALK from January 2003 to January 2011. MAIN OUTCOME MEASURE: Visual outcome and complications. RESULTS: Twenty-six eyes of 26 children (13 male and 13 female) with a mean age of 7.82 +/- 4.64 years underwent DALK for keratoconus (8), microbial keratitis (6), corneal scar (6), corneal keloid (3), chemical injury with limbal stem cell deficiency (2), and dermoid (1). Big bubble was achieved in 5 eyes, while manual dissection was done in 21. Follow-up ranged from 1 week to 7.3 years. Seventeen patients with a minimal follow-up of 6 months were evaluated for visual outcomes. Final vision varied from counting fingers to 20/20 (mean sphere 2.32 diopters, mean cylinder -2.5 diopters). Complications encountered were suture-related graft infiltrate (3), graft dehiscence (3), and Descemet membrane detachment (2). CONCLUSIONS : DALK is a feasible option in children with stromal corneal pathology. It offers advantages in the form of lower risk of graft rejection. However, the risk of complications such as suture-related infections and graft dehiscence persists even in these cases. (Am J Ophthalmol 2013;155:570-574. (C) 2013 by Elsevier Inc. All rights reserved.)