Anterior Lamellar Keratoplasty Over Penetrating Keratoplasty for Optical, Therapeutic, and Tectonic Indications: A Case Series

PURPOSE: To report a consecutive case series of patients who underwent anterior lamellar keratoplasty (ALK) over a preexisting penetrating keratoplasty (PK). DESIGN: Retrospective, interventional case series. METHODS: Eight patients (8 eyes) were identified from the Singapore Corneal Transplant Study database, in a single institution (Singapore National Eye Center) from patients who underwent ALK performed over a PK. Main outcome measures were final visual acuity (VA), graft failure (ALK, PK or both), successful restoration of tectonic integrity in tectonic indications, and eradication of infection in therapeutic cases. RESULTS: The indications for surgery were therapeutic in 3 patients, optical in 3 patients, and tectonic in 2 patients. Postoperatively the best-corrected visual acuity (BCVA) improved in 5 eyes and remained unchanged in 3 eyes. Mean VA improved significantly after ALK; the mean preoperative BCVA was 1.52 +/- 0.25 and the mean postoperative BCVA was 0.87 +/- 0.26 (P = .032). Three of the 8 eyes post-lamellar keratoplasty (LK) managed to attain a BCVA equal to post PK BCVA. Two patients had suture micro-perforations while I patient required a repeat ALK for recurrence of infection. CONCLUSION: ALK may be a considered as a viable alternative to a repeat PK for a variety of optical, therapeutic, and tectonic indications. (Am J Ophthalmol 2009;147:697-702. (C) 2009 by Elsevier Inc. All rights reserved.)