Results of Deep Anterior Lamellar Keratoplasty for Advanced Keratoconus in Children Less Than 18 Years

PURPOSE: To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children with advanced keratoconus. DESIGN: Retrospective noncomparative interventional case series. METHODS: A retrospective analysis was conducted of 20 eyes of 16 patients who underwent deep anterior lamellar keratoplasty at a tertiary eye care center for advanced keratoconus. The main preoperative parameters measured were decimal uncorrected visual acuity (UCVA), decimal best-corrected visual acuity (BCVA), and average keratometry. The average keratometry was taken as an average of the flat and steep keratometric readings. The follow-up ranged from 24 to 105 months. The main outcome measures were UCVA, BCVA, steep and flat simulated keratometry, refraction, graft clarity, and complications. RESULTS: At the final follow-up, 18 patients had clear grafts in the visual axis area. Mean decimal UCVA changed from 0.06 +/- 0.08 to 0.24 +/- 0.09. Mean decimal BCVA changed from 0.12 +/- 0.19 to 0.45 +/- 0.24. The average keratometry decreased from 64.15 diopter (D) to 45.7 D after surgery. The complications noted in the patients were graft rejection (1), shield ulcers (2), graft infection (2), and interface vascularization (4). They were managed accordingly and only 1 patient needed penetrating keratoplasty. CONCLUSIONS: DALK is an effective therapeutic modality for the management of advanced keratoconus in children. (C) 2016 by Elsevier Inc. All rights reserved.