Air-Assisted Manual Deep Anterior Lamellar Keratoplasty for Treatment of Herpetic Corneal Scars

Purpose: To evaluate the prognosis and results of deep anterior lamellar keratoplasty (DALK) by intrastromal air injection for corneal opacity after herpes simplex keratitis. Methods: Retrospective analysis of 12 eyes of 12 patients, with minimum follow-up of 15 months. To reduce the risk of perforation in scarred corneas, DALK was performed by a more superficial intrastromal air injection, avoiding the formation of a big bubble, followed by manual dissection to a near-Descemetic level. Oral acyclovir (1200 mg daily) was started 1 month before Surgery and continued for 5 months, then tapered to 800 mg daily for further 6 months. Results: DALK was successfully completed in all 12 eyes. No cases of rejection or recurrent keratitis were observed. One case with cataract and diabetic retinopathy is excluded from statistics. At 15 months, the mean improvement of best spectacle-corrected Visual acuity was 0.51 (SD 0.19: range 0.3-0.9) (P < 0.05). In the 7 eyes in which preoperative spherical equivalent was known, a mean myopic shift of 2.38 diopters (D) (SD 1.15 D) was observed (P < 0.05). Mean postoperative defocus equivalent was 5.89 D (SD 2.51 D). Mean postoperative refractive astigmatism was 2.66 D (SD 0.99 D: range 1.5-5 D). Moderate interface opacity was transitorily observed in 4 cases for 2-6 months. In the patient with cataract, cataract extraction was Successfully completed without complications. Conclusion: DALK for postherpetic leukoma had a safe intraoperative profile and resulted in a significant visual recovery, with a 2-D myopic shift.