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Refractive outcomes of penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes for keratoconus

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Abstract

Purpose

To compare the refractive outcomes following penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes in patients with keratoconus.

Methods

This is an observational retrospective review of consecutive patients with keratoconus first managed with penetrating keratoplasty in one eye and then with lamellar keratoplasty in the fellow eye, between 2002 and 2007. Data collection was based on patients’ hospital records. Information related to assessment before surgery and at 1, 3, 6, 12, 24, and 48 months after keratoplasty were retrieved and considered in the analysis. Clinical evaluations included patients’ medical histories and diagnosis of keratoconus, uncorrected and best corrected visual acuity, spherical equivalent, refractive cylinder, topographic cylinder, and high-order aberrations, complications, and adverse reactions. Data on contrast sensitivity, central corneal thickness, and central residual bed thickness (only for lamellar keratoplasty) were retrieved from anterior segment optical coherence tomography observation performed at 48 months.

Results

Sixteen patients (32 eyes), 7 males and 9 females, were included in the analyses. After 4 years from transplantation, at the end of follow-up, no statistically significant differences were found in visual acuity and refractive measures between the two keratoplasties. Perforating keratoplasty showed significant differences for contrast sensitivity at 6 cpd with maximum glare (p = 0.026) and without glare (p = 0.015). Deep anterior lamellar keratoplasty showed a negative correlation between central residual bed thickness and best corrected visual acuity (R = −0.414, p < 0.001).

Conclusions

The manual pre-descemetic deep anterior lamellar keratoplasty used in this study showed refractive and visual results comparable to those obtained with penetrating keratoplasty. Such results indicated that leaving healthy stroma attached to Descemet’s membrane does not compromise the clinical outcome in the short and long term after surgery.

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Author's contribution

EP, MP, and SFi designed the study and collected the data. EP, GM, MP, and SFi performed surgery and took part in the clinical management of the patients. EP, MP, AF, and SFe made the analysis and composed the manuscript. GM reviewed and approved the manuscript.

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Authors and Affiliations

  1. Department of Neurosciences, Biomedicine, and Movement Sciences, Eye Clinic, University of Verona, Ospedale Maggiore, P.Le A. Stefani 1, 37126, Verona, Italy

    Emilio Pedrotti, Mattia Passilongo, Sara Ficial & Giorgio Marchini

  2. Fondazione Banca degli Occhi Del Veneto (The Veneto EyeBank Foundation), Via Paccagnella, 11 Zelarino, 30174, Venice, Italy

    Adriano Fasolo & Stefano Ferrari

Authors
  1. Emilio Pedrotti
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  2. Mattia Passilongo
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  3. Adriano Fasolo
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  4. Sara Ficial
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  5. Stefano Ferrari
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  6. Giorgio Marchini
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Corresponding author

Correspondence to Mattia Passilongo.

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Pedrotti, E., Passilongo, M., Fasolo, A. et al. Refractive outcomes of penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes for keratoconus. Int Ophthalmol 37, 911–919 (2017). https://doi.org/10.1007/s10792-016-0350-0

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  • DOI: https://doi.org/10.1007/s10792-016-0350-0

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