Descemetic deep anterior lamellar keratoplasty versus penetrating keratoplasty in advanced keratoconus: comparison of visual and refractive outcomes

PURPOSE: To compare visual and refractive outcomes after Descemetic deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) in the management of advanced stage of keratoconus. DESIGN: retrospective study. METHODS: This study enrolled keratoconus eyes with preoperative mean keratometry ≥60 diopters (D) that were treated with either Descemetic DALK (30 eyes) or PK (29 eyes). The outcome measures were postoperative distance-corrected visual acuity (DCVA), as well as refractive and keratometric astigmatism. RESULTS: Compared with baseline values, postoperative visual acuity significantly improved in both groups. Mean DCVA was higher in the DALK group 3 months (PK: 0.43, DALK: 0.69, p = 0.008), 6 months (PK: 0.43, DALK: 0.69, p 0.01) and 12 months (PK: 0.45, DALK: 0.72, p = 0.02) postoperatively. However, 6 months after suture removal, DCVA was not statistically different between the two groups (PK: 0.75, DALK: 0.71 p= 0.770). Final refractive astigmatism and keratometric astigmatism also were comparable between the two groups (respectively: PK: 2.81, DALK: 2.97, p = 0.853; PK: 2.37, DALK: 3.91, p = 0.853). CONCLUSION: Both techniques of corneal transplantation led to a significant improvement in the visual and refractive outcomes in eyes with advanced keratoconus. DALK resulted in better visual 2 acuity before suture removal, while PK and DALK performed equally in terms of visual acuity, refractive and keratometric astigmatism after suture removal.