Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus

Sir,

I congratulate the authors, CL Funnell et al¹ for publishing the outcomes of their keratoplasty surgery. I would like to make the following comments:

I do partial trephination of the cornea before lamellar dissection and find this step helps to limit the surgery, to the required area.

I note that five patients in each group required resuturing of the corneal graft. I would be interested in knowing the reasons of this complication. I tend to use single continuous sutures in my deep lamellar surgery and tie the sutures reasonably tight. Fortunately, I did not have to resuture any of my nine deep lamellar patients. In my experience, I found that the donor and the recipient suture bites may have to be at different depths so as to avoid a ‘step’.

At present, we are conducting a prospective study measuring the residual stromal/Descemet's bed thickness and correlating with the visual outcome.