C Cursiefen1, F Schaub2, B Bachmann1. 1. Zentrum für Augenheilkunde, Universität zu Köln, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland. 2. Zentrum für Augenheilkunde, Universität zu Köln, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland. friederike.schaub@uk-koeln.de.
Abstract
BACKGROUND: The treatment of keratoconus has been significantly expanded in recent years. In addition to the previous options for correction by fitting hard contact lenses and penetrating keratoplasty (PK), corneal cross-linking and lamellar transplantation techniques have been added. OBJECTIVE: The aim of this review article is to highlight currently available options for minimization of complications and standardization of deep anterior lamellar keratoplasty (DALK) for keratoconus. MATERIAL AND METHODS: This article summarizes our own data and gives a review of the literature in PubMed. RESULTS: Performing DALK can provide keratoconus patients with corneal grafts with considerably longer graft survival and a reduced risk of complications. CONCLUSION: The DALK procedure provides numerous advantages over PK, especially the reduced intraoperative opening of the eye, which thus reduces the risk of serious intraoperative complications. A further benefit is the complete absence of postoperative endothelial immune reactions as the recipient's endothelium remains untouched. The absence of endothelial immune reactions is especially advantageous for young patients with keratoconus and patients with an increased risk of graft rejection, e.g. in atopic dermatitis; however, there are also typical complications of DALK that do not occur during PK. The outlined strategies for standardization of DALK and avoidance of intraoperative and postoperative complications should make DALK safer and more reproducible and lead to possible establishment as a standard procedure in keratokonus.
BACKGROUND: The treatment of keratoconus has been significantly expanded in recent years. In addition to the previous options for correction by fitting hard contact lenses and penetrating keratoplasty (PK), corneal cross-linking and lamellar transplantation techniques have been added. OBJECTIVE: The aim of this review article is to highlight currently available options for minimization of complications and standardization of deep anterior lamellar keratoplasty (DALK) for keratoconus. MATERIAL AND METHODS: This article summarizes our own data and gives a review of the literature in PubMed. RESULTS: Performing DALK can provide keratoconus patients with corneal grafts with considerably longer graft survival and a reduced risk of complications. CONCLUSION: The DALK procedure provides numerous advantages over PK, especially the reduced intraoperative opening of the eye, which thus reduces the risk of serious intraoperative complications. A further benefit is the complete absence of postoperative endothelial immune reactions as the recipient's endothelium remains untouched. The absence of endothelial immune reactions is especially advantageous for young patients with keratoconus and patients with an increased risk of graft rejection, e.g. in atopic dermatitis; however, there are also typical complications of DALK that do not occur during PK. The outlined strategies for standardization of DALK and avoidance of intraoperative and postoperative complications should make DALK safer and more reproducible and lead to possible establishment as a standard procedure in keratokonus.
Authors: Joachim M Braun; Carmen Hofmann-Rummelt; Ursula Schlötzer-Schrehardt; Friedrich E Kruse; Claus Cursiefen Journal: Acta Ophthalmol Date: 2011-08-11 Impact factor: 3.761
Authors: William J Reinhart; David C Musch; Deborah S Jacobs; W Barry Lee; Stephen C Kaufman; Roni M Shtein Journal: Ophthalmology Date: 2011-01 Impact factor: 12.079
Authors: Abdullah A Al-Torbak; Saeed Al-Motowa; Abdullah Al-Assiri; Soliman Al-Kharashi; Sami Al-Shahwan; Hani Al-Mezaine; Klaus Teichmann Journal: Cornea Date: 2006-05 Impact factor: 2.651
Authors: Friederike Schaub; Philip Enders; Björn O Bachmann; Ludwig M Heindl; Claus Cursiefen Journal: Graefes Arch Clin Exp Ophthalmol Date: 2017-01-30 Impact factor: 3.117
Authors: Alexander Händel; Jan Niklas Lüke; Sebastian Siebelmann; Jeremy Franklin; Sigrid Roters; Mario Matthaei; Björn O Bachmann; Claus Cursiefen; Deniz Hos Journal: Graefes Arch Clin Exp Ophthalmol Date: 2022-04-07 Impact factor: 3.535
Authors: Friederike Schaub; Philip Enders; Werner Adler; Björn O Bachmann; Claus Cursiefen; Ludwig M Heindl Journal: BMC Ophthalmol Date: 2017-11-17 Impact factor: 2.209