Comparison Of Full Bed Deep Lamellar Keratoplasty Vs Penetrating Keratoplasty In Congenital Corneal Stromal Disease

Objective: To compare the therapeutic outcomes after full bed deep lamellar keratoplasty (FB-DLKP) and penetrating keratoplasty (PKP) in congenital corneal stromal disease(CCSD).Participants and Methods: Retrospective case-control study. We reviewed the clinical notes of 52 eyes of 47 patients who had received FB-DLKP (26 eyes of 24 patients) or PKP (26 eyes of 25 patients) from Apr. 2002 to Dec. 2005. Full bed deep lamellar keratoplasty was performed with the technique described by Yao. Penetrating keratoplasty was performed with a standard technique using a hand-holding trephine. A single continuous 16-bite 10-0 nylon suture was placed in both groups. The procedure of operations, best corrected visual acuity (BCVA), refractive results, complication and recurrence of the primary disease were analyzed. Results: The 26 eyes of 24 patients who underwent FB-DLKP had a mean age of 25.8 years and a median follow-up of 16.3 months. The mean age of the 26 eyes of 25 patients who underwent PKP was 24.2 years and a median follow-up of 35.0 months. The patients in the two groups were matched for preoperative visual acuity, gender, age, donor diameter. The average operative time for PKP was 43.2 minutes, compared with 74.3 minutes for FB-DLKP (t-test p=0.000). Microperforation of Descemet's membrane occurred in 3 eyes (11.5%) of FB-DLKP series. The median final BCVA of patients was 0.6 in both FB-DLKP and PKP groups (no statistical significance). The median result for the final spherical equivalent power in both groups was mild myopia (-2.18DS in FB-DLKP group and -1.38DS in PKP group), and the medianastigmatism was 4.00DC and 4.50DC for FB-DLKP and PKP group respectively (no statistical significance). The rates of postoperative ocular hypertension, glaucoma, rejection was 61.5%(16 eyes), 19.2%( eyes), 7.7%(2 eyes) and 12.2%(6 eyes) in PKP group respectively, but no donor failure. Postoperative ocular hypertension only occurred in 3.8% (1 eye) of the FB-DLKP group, and no glaucoma, rejection and donor failure. The difference of the rate of postoperative ocular hypertension, glaucoma between two groups was statistically significant. No recurrence occurs. Conclusions: Best-corrected visual acuity, refractive results are similar after FB-DLKP and PKP. Less risk for postoperative complications in FB-DLKP group than in PKP group. However, FB-DLKP is a more time-consuming and technically difficult procedure than PKP. We suggest FB-DLKP in CCSD.