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Stromal Rejection after Deep Anterior Lamellar Keratoplasty (DALK) - A Retrospective Study
Authored by Vipul Bhandari
Aim: To report and analyse the
incidence of stromal rejction, which is a central island of flattening
of the graft associated with thinning in
patients who underwent DALK for keratoconus.
Materials & Methods:
Retrospective review of patients who underwent DALK for progressive
keratoconus from 2010 to 2013 was
done. Patients who completed 2 years of follow up were included. Slit
lamp findings, corneal topography and central corneal thickness were
analysed.122 eyes of 71 patients were analysed. Uncorrected visual
acuity (UCVA) and best corrected visual acuity (BCVA) were analysed in
each visit
Results: Thirty one eyes of thirty
one patients showed topographic evidence of Central Island of flattening
which correlated with slit lamp finding of stromal haze of varying
density. The pachymetry reading of the central cornea varied from 400 to
479μ and correlated with
topographic finding of flattening. The average onset of central stromal
haze was at 9 months post DALK. None of the patients had bilateral
involvement. The central haze progressed over time and was associated
with thinning of the cornea. The onset and progression of central
flattening was associated with corresponding decrease in UCVA and BCVA.
No epithelial defect was noted.
Conclusion: 25.4% of keratoconus
patients who underwent DALK developed a central island of flattening
with associated decrease in the visual acuity. The central haze,
flattening and thinning may be a chronic stromal rejection or
progressive thinning of cornea associated with
disease process of keratoconus.
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