Therapeutics and Clinical Risk Management (Feb 2024)

Descemetic Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty in Advanced Keratoconus: Comparison of Visual and Refractive Outcomes

  • Spadea L,
  • Di Genova L,
  • Trovato Battagliola E,
  • Scordari S

Journal volume & issue
Vol. Volume 20
pp. 127 – 138

Abstract

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Leopoldo Spadea, Lucia Di Genova, Edoardo Trovato Battagliola, Stefano Scordari Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, Rome, ItalyCorrespondence: Leopoldo Spadea, Head Eye Clinic, Policlinico Umberto I, “Sapienza” University of RomeVia Benozzo Gozzoli 34, Rome, 00142, Italy, Tel +39065193220, Fax +390688657818, Email [email protected]: To assess and contrast the visual and refractive results of Descemetic deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in the treatment of advanced keratoconus.Design: Retrospective, comparative, interventional study.Methods: This study enrolled eyes affected by keratoconus with preoperative mean keratometry ≥ 60 diopters (D) that were treated with either Descemetic DALK (30 eyes) or PK (29 eyes) by using always the same corneal diameters (8.00mm recipient; 8.25mm donor cornea) and the same suture technique (10– 0 nylon double-running 12-bites continuous suture). The outcome measures were postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive astigmatism (SRAst), and keratometric astigmatism at 3mm area (SimK), spherical equivalent (SEq).Results: Postoperative visual acuity significantly improved in both groups. Mean CDVA was higher in the DALK group 3 months (DALK 0.61, PK 0.42, p 0.05). Final SRAst and SimK also were comparable between the two groups (respectively DALK 2.97, PK:2.81, p> 0.05; DALK 3.91, PK 2.37, p> 0.05). No significant statistical differences were noted for UCVA and SEq data during the entire follow-up period between the two groups.Conclusion: Both methods of corneal transplantation resulted in a notable enhancement of visual and refractive outcomes in eyes afflicted by advanced keratoconus. Descemetic DALK demonstrated superior visual acuity before suture removal, whereas DALK and PK exhibited comparable results in terms of visual acuity, refractive correction, and keratometric astigmatism after suture removal.Keywords: astigmatism, corneal topography, descemetic dalk, keratoconus, PK

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