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Long‐term outcomes of hemi‐automated lamellar keratoplasty
Author(s) -
Fuest Matthias,
Liu YuChi,
Arundhati Anshu,
Li Lim,
Tan Donald,
Mehta Jodhbir S
Publication year - 2018
Publication title -
clinical and experimental ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.3
H-Index - 74
eISSN - 1442-9071
pISSN - 1442-6404
DOI - 10.1111/ceo.13331
Subject(s) - medicine , visual acuity , ophthalmology , scars , astigmatism , prospective cohort study , surgery , optics , physics
Importance To describe long‐term outcomes of hemi‐automated lamellar keratoplasty (HALK). Background HALK is a hybrid anterior lamellar keratoplasty technique for corneas with anterior to mid‐stromal scars and topographical irregularities. Design Prospective interventional case series. Participants Thirty‐five eyes of 35 consecutive patients undergoing HALK at a single tertiary referral centre from 2007 to 2016. Methods Patients were followed up for a mean period of 61.4 ± 29.2 months. Main Outcome Measure Uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA), spherical equivalent (SE) and cylinder, endothelial cell density (ECD), central corneal thickness (CCT), graft survival and complications were analysed. Results The most common indications for HALK were scars because of contact lens associated infectious keratitis (29%), unknown origin (26%) or corneal dystrophies (14%). Five patients had a previous keratoplasty ( n = 4; deep anterior lamellar keratoplasty, n = 1). Two HALKs failed at 22 and 32 months follow‐up. No graft rejections occurred. UCVA improved from 0.91 ± 0.31 to 0.58 ± 0.35 and BSCVA from 0.66 ± 0.30 to 0.21 ± 0.20 logMAR ( P < 0.001) at the last follow‐up. Astigmatism ( P = 0.2), SE ( P = 0.8) and ECD ( P = 0.4) did not change significantly during follow‐up. CCT increased from 490 to 560 μm ( P = 0.004). Kaplan–Meier estimated survival for all HALK cases was 90.6 (95% confidence interval 82.6–98.5) months with a survival probability of 96% at 12 months and 92% at 3, 5 and 7 years of follow‐up. Conclusions and Relevance HALK provides excellent graft survival in primary cases and in patients with prior keratoplasty as well as significant improvement in visual acuity with low complication rates.