Deep anterior lamellar keratoplasty in advanced keratoconus in children: A 4-year study

The purpose of the study was to evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children and adolescents with advanced keratoconus (KC) at a tertiary eye care center in India. This was a retrospective cross-sectional study. All cases of KC under the age group of 18 years, operated for DALK at a tertiary eye care center in South India, were evaluated from January 2018 to January 2022; outcome measures were best-corrected visual acuity (BCVA), graft clarity at final follow-up, and complications. Of 27 eyes of 25 cases, 16 were male and 9 were female, with a mean age of presentation at 14.9 years. In stromal dissection technique, big bubble was attempted in 23 eyes and achieved in 20 eyes; manual dissection was done for the rest of the cases. Final BCVA varied from 0.1 to 0.6 logMAR units. Twenty-three eyes had excellent graft clarity at final follow-up. Complications noted in the study were intraoperative microperforation in four cases, postoperatively suture-related complications in three cases, and corneal graft rejection in one case. DALK in pediatric age group for advanced KC is an effective treatment option.