[Graft refractive surgery for post-DALK atigmatism in keratoconus]

ABSTRACT

Evaluate the effect of relaxing incision and adjustment sutures to correct astigmatism after deep anterior lamellar keratoplasty [DALK] in patients with keratoconus. This interventional case series included keratoconic eyes undergoing graft refractive surgery [GRS] for intolerable post-DALK astigmatism. The technique of graft refractive surgery for the 5 initial cases consisted of relaxing incisions at the steep meridian in the graft-host interface down to Descemet's membrane. The main outcomes were uncorrected and best-corrected visual acuity, and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Fourteen eyes of 14 keratoconic patients [12 male subjects] with history of DALK underwent GRS. Mean age of the patients was 29.36 +/- 6.2 years and mean follow-up period was 12.0 +/- 7.4 months after initial GRS. Mean preoperative BCVA was 0.29 +/- 0.1 logMAR which improved to 0.22 +/- 0.1 logMAR after the operation [P=0.007]. Average keratometric astigmatism was reduced by 3.8 D and 5.5 D as measured by subtraction and vector analysis methods, respectively. Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus