Deep anterior lamellar vs penetrating keratoplasty for macular and granular stromal dystrophies: clinical and refractive results

To evaluate and compare visual, refractive, and keratometric outcomes and complications in patients who underwent Deep Anterior Lamellar Keratoplasty (DALK) and Penetrating Keratoplasty (PKP) surgery for stromal corneal dystrophies. This retrospective study included 35 eyes that underwent keratoplasty for stromal corneal dystrophy. The eyes were divided into 4 groups according to dystrophy type and surgical procedure. In the macular corneal dystrophy (MCD) group, 13 PKP, 6 DALK; in the granular corneal dystrophy (GCD) group, 10 PKP, 6 DALK surgeries were performed. Compared to the preoperative period, there was a significant increase in BCVA at 1 year postoperatively for all groups ( p < 0.05). 1-year graft survival after PKP was 84.6% and 100% in the MCD and GCD groups, respectively. Whereas it was 83.3% after DALK in both groups. Two cases of endothelial graft rejection occurred in the MCD-PKP group, while one case of stromal graft rejection was observed in the MCD-DALK group. Additionally, one instance of disease recurrence was seen in each of the following groups: MCD-PKP, MCD-DALK, and GCD-DALK. These findings suggest that DALK may provide acceptable visual, refractive, and graft survival outcomes in selected patients with stromal corneal dystrophies. Given its closed-sky surgical nature and lower risk of endothelial rejection, DALK may be considered a suitable alternative to PKP in appropriately selected cases.