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Impact of topographic localization of corneal ectasia on the outcomes of deep anterior lamellar keratoplasty employing large (9 mm) versus conventional diameter (8 mm) grafts

Eye volume 37, pages 3477–3483 (2023)Cite this article

Subjects

Abstract

Objectives

Visual and topographic outcomes of large (9.0 mm) versus conventional (8.0 mm) deep anterior lamellar keratoplasty (DALK) for the treatment of keratoconus (KC) were compared in relation to the different localization of the corneal ectasia (within or beyond the central 8.0 mm).

Methods

This is a retrospective, comparative case series. Preoperatively, the topographic extension of the conus was calculated by measuring the distance from the geometric center of the cornea and the outermost point of the corneal ectasia (ectasia <8.0 mm, group A; ectasia ≥8.0 mm, group B). DALK was performed using both small grafts (8.0 mm, group 1) and large grafts (9.0 mm, group 2). Best-corrected visual acuity and topographic astigmatism were evaluated preoperatively (T0) and postoperatively after complete suture removal (1 year, T1).

Results

Data from 224 eyes of 196 patients (mean age 37.6 ± 15.1 years) were evaluated. Topographic astigmatism improved from T0 to T1 (4.94 ± 2.92 diopters (D) [95% CI, 4.56–5.33] vs 4.19 ± 2.45 D [95% CI, 3.87–4.51], p = 0.001). There was no significant difference in postoperative topographic cylinder between group 1 and group 2 when considering eyes with corneal ectasia <8.0 mm (group 1 A, 4.15 ± 2.19 D [95% CI, 3.64–4.66] vs group 2 A, 3.65 ± 2.13 D [95% CI, 2.92–4.38], p = 0.14); conversely, the difference was significant considering eyes with corneal ectasia ≥8.0 mm (group 1B, 4.74 ± 2.90 D [95% CI, 4.09-5.38] vs group 2B, 3.68 ± 1.94 D [95% CI, 3.10–4.26], p = 0.02).

Conclusions

Large 9.0-mm DALK provided better anatomical outcomes compared to conventional 8.0-mm DALK, particularly in eyes with corneal ectasia extending beyond the central 8.0 mm.

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Fig. 1: Preoperative assessment of the topographic localization of corneal ectasia.
Fig. 2: Number of eyes belonging to each study group, according to both graft size and topographic localization of the conus.
Fig. 3: Postoperative topographic cylinder (diopters [D]), group 1A vs 2A and group 1B vs 2B.
Fig. 4: Both corneal maps show a corneal ectasia extending beyond 8.0 mm.

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Data availability

Data are available upon reasonable request.

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Author notes

  1. These authors contributed equally: Andrea Lucisano, Vincenzo Scorcia.

Authors and Affiliations

  1. Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy

    Andrea Lucisano, Vincenzo Scorcia, Andrea Taloni, Costanza Rossi, Raffaella Gioia & Giuseppe Giannaccare

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  1. Andrea Lucisano
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  2. Vincenzo Scorcia
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Contributions

Conceptualization, GG, AL, VS; Methodology, GG and AT; Validation, GG, VS and AL; Formal analysis, AL, AT, RG, CR; Investigation, GG, VS, AL, CR, RG and AT; Data curation, AT, RG and CR; Writing – original draft preparation, AT, RG, CR and GG; Writing – review & editing, AT, GG, AL, and VS; Visualization, AL, AT, VS, G.G., RG, CR; Supervision, GG, VS and AL; Project Administration, VS and GG All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Vincenzo Scorcia.

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Competing interests

The authors declare no competing interests.

Ethics

This study followed the tenets of the 2013 Declaration of Helsinki. The study was approved by the local ethics committee (Comitato Etico Area Centro, Regione Calabria - Protocol No. 150/22).

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Written informed consent was obtained by all patients undergoing surgery.

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Lucisano, A., Scorcia, V., Taloni, A. et al. Impact of topographic localization of corneal ectasia on the outcomes of deep anterior lamellar keratoplasty employing large (9 mm) versus conventional diameter (8 mm) grafts. Eye 37, 3477–3483 (2023). https://doi.org/10.1038/s41433-023-02536-6

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  • DOI: https://doi.org/10.1038/s41433-023-02536-6

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