Early results for lamellar and endothelial corneal transplantation techniques were inferior to penetrating keratoplasty, according to the results of a large study conducted in Australia.
“The new procedures of lamellar keratoplasty that have evolved over the past two decades have been adopted enthusiastically by corneal surgeons worldwide. Although outcomes have been promoted as being significantly better than those of the well-established alternative of penetrating keratoplasty, the evidence for this claim is unconvincing outside of single-center studies,” the authors wrote in the study.
The prospective cohort study included 13,920 PKs, 858 deep anterior lamellar keratoplasties and 2,287 endothelial keratoplasties performed between 1996 and 2013. Using data from the Australian Corneal Graft Registry, the researchers assessed graft survival, surgeon experience, visual acuity and surgeon learning curves.
PKs for keratoconus had significantly better graft survival (P < .001) and visual outcomes (P < .001) than DALKs. Additionally, PKs had better graft survival rates than endothelial procedures for Fuchs’ dystrophy or pseudophakic bullous keratopathy, according to the researchers (P < .001).
Penetrating grafts had better visual outcomes than endothelial techniques for Fuchs’ dystrophy (P < .001). However, endothelial procedures yielded better visual outcomes than PKs for pseudophakic bullous keratopathy (P < .001).
Graft survival was significantly greater among experienced surgeons who had performed more than 100 endothelial procedures than for surgeons who had performed fewer than 100 such procedures, the researchers found (P < .001).
The authors have no relevant financial disclosures.