{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:24:56Z","timestamp":1780071896805,"version":"3.54.0"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T00:00:00Z","timestamp":1530057600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Importance<\/jats:title><jats:p>To describe long\u2010term outcomes of hemi\u2010automated lamellar keratoplasty (HALK).<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>HALK is a hybrid anterior lamellar keratoplasty technique for corneas with anterior to mid\u2010stromal scars and topographical irregularities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective interventional case series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Thirty\u2010five eyes of 35 consecutive patients undergoing HALK at a single tertiary referral centre from 2007 to 2016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were followed up for a mean period of 61.4\u2009\u00b1\u200929.2 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure<\/jats:title><jats:p>Uncorrected visual acuity (UCVA), best spectacle\u2010corrected visual acuity (BSCVA), spherical equivalent (SE) and cylinder, endothelial cell density (ECD), central corneal thickness (CCT), graft survival and complications were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The most common indications for HALK were scars because of contact lens associated infectious keratitis (29%), unknown origin (26%) or corneal dystrophies (14%). Five patients had a previous keratoplasty (<jats:italic>n<\/jats:italic>\u2009=\u20094; deep anterior lamellar keratoplasty,<jats:italic>n<\/jats:italic>\u2009=\u20091). Two HALKs failed at 22 and 32\u2009months follow\u2010up. No graft rejections occurred. UCVA improved from 0.91\u2009\u00b1\u20090.31 to 0.58\u2009\u00b1\u20090.35 and BSCVA from 0.66\u2009\u00b1\u20090.30 to 0.21\u2009\u00b1\u20090.20 logMAR (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) at the last follow\u2010up. Astigmatism (<jats:italic>P<\/jats:italic>\u2009=\u20090.2), SE (<jats:italic>P<\/jats:italic>\u2009=\u20090.8) and ECD (<jats:italic>P<\/jats:italic>\u2009=\u20090.4) did not change significantly during follow\u2010up. CCT increased from 490 to 560\u2009\u03bcm (<jats:italic>P<\/jats:italic>\u2009=\u20090.004). Kaplan\u2013Meier estimated survival for all HALK cases was 90.6 (95% confidence interval 82.6\u201398.5) months with a survival probability of 96% at 12\u2009months and 92% at 3, 5 and 7 years of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>HALK provides excellent graft survival in primary cases and in patients with prior keratoplasty as well as significant improvement in visual acuity with low complication rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.13331","type":"journal-article","created":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T08:15:05Z","timestamp":1527840905000},"page":"1017-1027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Long\u2010term outcomes of hemi\u2010automated lamellar keratoplasty"],"prefix":"10.1111","volume":"46","author":[{"given":"Matthias","family":"Fuest","sequence":"first","affiliation":[{"name":"Singapore Eye 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Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Tan","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute Singapore Singapore"},{"name":"Singapore National Eye Centre Singapore Singapore"},{"name":"Eye\u2010ACP, Duke\u2010NUS Graduate Medical School Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodhbir S","family":"Mehta","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute Singapore Singapore"},{"name":"Singapore National Eye Centre Singapore Singapore"},{"name":"Eye\u2010ACP, Duke\u2010NUS Graduate Medical School Singapore Singapore"},{"name":"School of Materials Science and Engineering Nanyang Technological University Singapore 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