Jinsong Xue1, Haiou Wang2,3, Min Wang2,3, Qingyan Zeng4, Vishal Jhanji5, Andy D Kim6, Michael T M Wang6, Yingnan Xu1, Xiuming Jin7, Wei Chen8,9. 1. The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. 2. Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China. 3. National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China. 4. Central South University Aier School of Opthalmology, Changsha, Hunan, China. 5. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 6. Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand. 7. Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China. 8. Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China. chenweimd@wmu.edu.cn. 9. National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China. chenweimd@wmu.edu.cn.
Abstract
PURPOSE: To compare outcomes of deep anterior lamellar keratoplasty (DALK) and corneal cross-linking (CXL) in patients with advanced keratoconus, with the primary aim of assessing CXL as a potential therapeutic alternative. STUDY DESIGN: Retrospective, multi-center, comparative study. METHODS: Patients with advanced keratoconus (maximum keratometry reading (K-max) > 58D, best spectacle-corrected visual acuity worse than 0.52logMAR), undergoing either DALK or CXL treatment at four tertiary ophthalmic centers in Wenzhou, Hangzhou, Nanjing and Wuhan were included. Visual acuity, refractive error, corneal topography and complications were evaluated at baseline and at least 2 year postoperatively. RESULTS: 75 eyes of 72 patients were included, of which 37 eyes underwent DALK and 38 eyes, CXL. A larger reduction in Kmax was observed in the DALK group (-18.18 ± 9.44 D versus -1.10 ± 2.70D, p < 0.001). Seven eyes (18%) in the CXL group showed progression of keratoconus. No disease progression was observed in the DALK group. Greater improvements in best spectacle-corrected visual acuity (logMAR) were observed in the DALK group (-0.59 ± 0.25 versus -0.24 ± 0.44, p < 0.001). CONCLUSIONS: Compared to CXL, DALK leads to larger reductions in Kmax and better improvement in visual acuity in advanced keratoconus.
PURPOSE: To compare outcomes of deep anterior lamellar keratoplasty (DALK) and corneal cross-linking (CXL) in patients with advanced keratoconus, with the primary aim of assessing CXL as a potential therapeutic alternative. STUDY DESIGN: Retrospective, multi-center, comparative study. METHODS: Patients with advanced keratoconus (maximum keratometry reading (K-max) > 58D, best spectacle-corrected visual acuity worse than 0.52logMAR), undergoing either DALK or CXL treatment at four tertiary ophthalmic centers in Wenzhou, Hangzhou, Nanjing and Wuhan were included. Visual acuity, refractive error, corneal topography and complications were evaluated at baseline and at least 2 year postoperatively. RESULTS: 75 eyes of 72 patients were included, of which 37 eyes underwent DALK and 38 eyes, CXL. A larger reduction in Kmax was observed in the DALK group (-18.18 ± 9.44 D versus -1.10 ± 2.70D, p < 0.001). Seven eyes (18%) in the CXL group showed progression of keratoconus. No disease progression was observed in the DALK group. Greater improvements in best spectacle-corrected visual acuity (logMAR) were observed in the DALK group (-0.59 ± 0.25 versus -0.24 ± 0.44, p < 0.001). CONCLUSIONS: Compared to CXL, DALK leads to larger reductions in Kmax and better improvement in visual acuity in advanced keratoconus.
Authors: Mohammed Ziaei; Hans R Vellara; Akilesh Gokul; Noor Q Ali; Charles N J McGhee; Dipika V Patel Journal: Clin Exp Ophthalmol Date: 2019-11-27 Impact factor: 4.207