Deep anterior lamellar keratoplasty over penetrating keratoplasty for host rim thinning and ectasia.

PURPOSES: To describe the technique and evaluate the outcomes of patients who had deep anterior lamellar keratoplasty (DALK) for ectasia within or outside the graft-host interface in a previous penetrating keratoplasty (PK).

DESIGN: Retrospective review of interventional case series.

PATIENTS: Seven eyes that underwent DALK for corneal ectasia after previous PK.

INTERVENTION: DALK encompassing the area of ectasia and the previous PK.

MAIN OUTCOME MEASURES: Uncorrected visual acuity, best spectacle-corrected visual acuity, keratometry and topography, and complications.

RESULTS: Seven eyes had DALK, 4 developed Descemet membrane tears, and 2 eyes had deep graft-host dehiscence from the previous PK intraoperatively. At 12 months, mean uncorrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.157 to 0.74. Mean best spectacle-corrected visual acuity improved from 0.82 to 0.37 at 12 months.

CONCLUSIONS: DALK can be successfully performed over a previous PK. Intraoperative Descemet tears or dehiscence of Descemet at the previous graft-host interface can complicate surgery, but if successfully managed can produce a significant improvement in visual acuity.