Randomized clinical trial of deep lamellar keratoplaty v penetrating keratoplaty

PURPOE: To propectively compare the afety and efficacy of deep lamellar keratoplaty (DLKP) and penetrating keratoplaty (PKP). DEIGN: Propective, randomized clinical trial. METHOD: Conecutive 26 eye of 24 patient who had tromal opacity without endothelial abnormalitie were randomly aigned to either PKP or DLKP. Bet-corrected viual acuity (BCVA), contrat viual acuity, glare tet, intraocular preure, corneal topography, endothelial denity, and pachymetry were meaured before and after urgery. REULT: Two eye in the DLKP had rupture of the Decemet membrane and one of the eye developed endothelial decompenation. One eye in the PKP group howed decreae in viion due to econdary glaucoma. None of the eye developed immunologic rejection. The PKP group howed a tendency of fater recovery in BCVA than the DLKP group, but the difference wa not tatitically ignificant. Contrat viual acuity, glare tet, and corneal topography did not how ignificant difference between the two group. The intraocular preure wa ignificantly higher at 12 month in the PKP group (P = .004), but not in the DLKP group (P = .41) compared with preoperative value. While the PKP group howed progreive decreae in endothelial denity over 24 month, thi wa not oberved in the DLKP group after urgery. Difference in endothelial denity at 24 month reached tatitical ignificance (P = .04). CONCLUION: We found that DLKP wa uperior to PKP in it afety uch a continuou decreae of endothelium or increae in intraocular preure. However, endothelial damage can alo occur in DLKP, epecially in cae of intraoperative Decemet membrane rupture. With the development of eaier urgical technique, DLKP may be a firt choice of keratoplaty in mot eye without endothelial abnormalitie.