Risk of post-DALK glaucoma appears low

This retrospective study found that the long-term risk of glaucoma following deep anterior lamellar keratoplasty (DALK) using a manual dissection technique appears to be low. The results indicate that ocular hypertension after DALK is infrequent and can be controlled on topical medication alone.

The authors reviewed all DALK procedures performed with manual dissection at a tertiary referral center in the United Kingdom from 2000 through 2005. The study included 58 patients (69 eyes) followed for a mean of 54.9 months (range, 6 to 95 months).

The initial diagnosis was keratoconus in 56 cases (81 percent), corneal scarring in four cases (5.8 percent), herpes simplex keratitis in four cases (5.8 percent), lattice dystrophy in four cases (5.8 percent) and corneal dermoid in one case.

Temporarily raised IOP thought to be related to topical steroid use occurred in 12 cases (20 percent). These cases were managed by a reduction in the frequency and/or potency of topical steroids and short-term IOP-lowering agents. None of these eyes had progressive disc changes or visual field defects suggestive of glaucoma, and all had well-controlled IOP on topical, single-drug therapy. Overall, there was a small insignificant rise in IOP after DALK (P = 0.11). Ocular hypertension requiring long-term treatment occurred in three eyes (5.1 percent).

Visual acuity in two patients who developed ocular hypertension was below the median value (6/9) at 6/12. A third patient had poor vision because of interface scarring and underwent PK.