Comparison of penetrating keratoplasty and deep anterior lamellar keratoplasty in keratoconus eyes with vernal keratoconjunctivitis.

PURPOSE

The purpose of the study is to compare outcomes after penetrating keratoplasty (PK) against deep anterior lamellar keratoplasty (DALK) for keratoconus in patients with vernal keratoconjunctivitis (VKC).

METHODS

Keratoconic patients with VKC who received PK ( = 55, group 1) or DALK ( = 62, group 2) were retrospectively enrolled. The Student's test, Mann-Whitney test, Fisher's exact test, chi-square test, and Kaplan-Meier survival curve were used to compare outcomes between the groups.

RESULTS

The follow-up period was 59.4 ± 44.1 and 62.4 ± 38.9 months in groups 1 and 2, respectively ( = 0.70). Postoperative best spectacle-corrected visual acuity was 0.24 ± 0.18 and 0.29 ± 0.19 logMAR, respectively ( = 0.13). Graft rejection occurred in 34.6% and 25.8% of eyes in groups 1 and 2, respectively ( = 0.30). Groups 1 and 2 were comparable in the rates of cataract (3.6% and 12.9%, respectively,  = 0.07) and high intraocular pressure (3.6% and 8.1%, respectively,  = 0.31). Compared with the eyes with inactive VKC, PK eyes that experienced postoperative disease reactivation had a higher rate of suture abscesses (10.9% 50.0%, respectively,  = 0.01) and suture-tract vascularization (6.5% 33.3%, respectively,  = 0.03). Similarly, disease reactivation significantly increased suture abscesses from 27.3% to 51.7% ( = 0.03) and suture-tract vascularization from 18.2% to 49.6% ( = 0.005) in the DALK group. The graft survival rates were 95.3% in group 1 and 87.9% in group 2 at the 4-year follow-up, with mean durations of 14.4 and 11.1 months, respectively ( = 0.20).

CONCLUSION

The results indicate no difference in outcomes between PK and DALK for keratoconus in patients with VKC. Postoperative VKC reactivation increased the rate of suture-related problems after both techniques of keratoplasty.