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Review
. 2020 Mar 22:12:2515841420913014.
doi: 10.1177/2515841420913014. eCollection 2020 Jan-Dec.

Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

Sepehr Feizi  1 , Amir A Azari  2
Affiliations
Review

Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

Sepehr Feizi et al. Ther Adv Ophthalmol. .

Abstract

The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor-recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision.

Keywords: complications related to the donor–recipient interface; deep anterior lamellar keratoplasty; epithelial abnormalities; graft failure; graft rejection; graft survival; herpetic keratitis; vascularization; vernal keratoconjunctivitis.

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Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Complications related to donor–recipient interface after deep anterior lamellar keratoplasty. (a) The formation of double anterior chamber that is characterized by graft stromal edema and recipient Descemet’s membrane nonattachment and (b) multiple folds are evident in the surgical interface.
Figure 2.
Figure 2.
Epithelial graft abnormalities after deep anterior lamellar keratoplasty. (a) Filamentary keratitis characterized by the presence of multiple filaments in a background of severe dry ocular surface and graft epithelial irregularities and (b) A persistent epithelial defect with characteristic heaped-up edges. The regenerated surface epithelium in other areas appears irregular and hazy. A bandage contact lens is placed on the eye.
Figure 3.
Figure 3.
Reactivation of vernal keratoconjunctivitis in a patient with keratoconus who underwent deep anterior lamellar keratoplasty. The photograph shows an injected eye with peripheral corneal vascularization involving both host and donor in addition to the presence of suture abscesses and graft epithelilal haziness.
Figure 4.
Figure 4.
Corneal graft vascularization after deep anterior lamellar keratoplasty. This late complication is characterized by invasion of blood vessels deep in the donor–recipient interface. Leakage of fluid, lipid, and proteinaceous materials from these vessels causes the interface haze as seen here.
Figure 5.
Figure 5.
Graft rejection after deep anterior lamellar keratoplasty. (a) Subepithelial rejection characterized by multiple patches of subepithelial infiltrates throughout the graft resembling those seen in viral epidemic keratoconjunctivitis and (b) stromal rejection characterized by sectoral stromal edema and infiltration in addition to vascular invasion of the peripheral graft.
Figure 6.
Figure 6.
Recurrence of herpes simplex keratitis after deep anterior lamellar keratoplasty. (a) A classic epithelial lesion in a corneal graft with a characteristic linear branching corneal ulcer (dendritic ulcer). (b) The epithelial lesion is examined after staining with fluorescein dye.
See this image and copyright information in PMC

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