Anwar versus Melles Deep Anterior Lamellar Keratoplasty for Keratoconus A Prospective Randomized Clinical Trial

Purpose: To compare the outcomes of 2 techniques (Anwar vs. Melles) of deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Design: Randomized, double-blind clinical trial. Participants: Fifty-seven eyes of 57 patients 20 to 35 years of age were enrolled. Methods: Patients with clinical diagnosis of keratoconus who were contact lens intolerant and whose corrected distance visual acuity (CDVA) was less than 20/80 were enrolled. Eligible eyes were allocated randomly into 2 groups: the Anwar technique (23 eyes) or the Melles technique (25 eyes). Main Outcome Measures: The primary outcome measure was CDVA. Secondary outcomes were spherical equivalent, contrast sensitivity, corneal aberrations, corneal biomechanical properties, endothelial cell count, and central corneal thickness. All outcomes were compared 15 months after surgery. Results: The CDVA was 0.17 +/- 0.09 logarithm of the minimum angle of resolution (logMAR) units and 0.18 +/- 0.11 logMAR units in the Anwar and Melles groups, respectively (P = 0.803). Spherical equivalent was -1.82 +/- 2.7 diopters (D) and -2.69 +/- 3.94 D in the Anwar and Melles groups, respectively (P = 0.155). Overall, the difference in photopic and mesopic contrast sensitivity function between the 2 groups was statistically significant (P < 0.05). There was no significant difference between 2 groups in total and higher-order aberrations up to the fifth order (P > 0.05 for all parameters). Corneal hysteresis was not significantly different between the 2 groups (9.9 +/- 0.8 vs. 9.9 +/- 0.6; P = 0.606). The corneal resistance factor was 10.02 +/- 0.8 and 10.13 +/- 0.76 (P = 0.509). There was no significant difference in percentage of endothelial cell loss between the 2 groups (1 +/- 2% vs. 1 +/- 3% in the Anwar and Melles groups, respectively; P = 0.869). Mean central corneal thickness was 525.56 +/- 47.87 mu m versus 504.64 +/- 54.20 mu m in the Anwar and Melles groups, respectively (P = 0.155). Conclusions: The Anwar and Melles techniques of DALK have comparable visual acuity and refractive outcomes, aberrometric profiles, biomechanical properties, corneal thicknesses, and endothelial cell densities. However, patients who underwent the Anwar technique showed better contrast sensitivity. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2013;120:252-259 (C) 2013 by the American Academy of Ophthalmology.