Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty in Pediatric Keratoconus: A 15-Year Retrospective Analysis.

Purpose: To evaluate the long-term visual, functional outcomes, and complications associated with Deep Anterior Lamellar Keratoplasty (DALK) in pediatric keratoconus (KC).

Methods: A retrospective analysis of children aged ≤18 years who underwent DALK for KC between February 2006 and April 2021. Data on preoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, surgical technique, and complications. The big bubble technique was preferred, with manual or hydrodissection used when necessary. Outcome measures included postoperative UCVA, BCVA, manifest refraction, epithelial healing time, and complications.

Results: A total of 348 eyes from 303 children (mean age of 14.62 ± 2.59 years) were analyzed. Preoperative corneal scarring was observed in 24.4%, and 27.9% had vernal keratoconjunctivitis. Big bubble technique was successful in 69.8% of eyes. Descemet membrane microperforation occurred in 38 cases (10.9%), and intracameral air tamponade was required in 29 eyes (48.3%). The mean epithelial healing time was 5.00 ± 6.09 days. Postoperatively, mean spherical correction improved from -8.43 ± 5.52D to -2.42 ± 2.60D, and mean refractive astigmatism from -4.65 ± 1.62D to -2.60 ± 1.87D. The UCVA improved from 1.26 ± 0.27 to 0.76 ± 0.32 Log MAR and BCVA from 0.64 ± 0.31 to 0.18 ± 0.17 Log MAR. Complications included graft vascularization in 14.7%, graft infections 6.9%, and glaucoma in 26.7.

Conclusions: DALK is a safe and effective procedure for managing pediatric KC, offering significant improvements in visual outcomes and refractive parameters with excellent graft survival rates over the long term.