Manual deep anterior lamellar keratoplasty alone or combined with lens surgery in patients with radial keratotomy.

Abstract

Introduction and objectives: This study aims to report the clinical outcomes of the manual deep anterior lamellar keratoplasty (M-DALK) performed alone or combined with lens surgery in post-radial keratotomy (post-RK) patients.

Patients and methods: This retrospective study included post-RK eyes that underwent M-DALK alone or combined with lens surgery. Corrected visual acuity (AVCC), manifest refraction, and intra- and postoperative complications were recorded.

Results: The study included 20 eyes, twelve eyes underwent M-DALK alone, and eight eyes combined with lens surgery. In two eyes in each group, a micro-perforation of the Descemet Membrane occurred during dissection, which did not prevent DALK completion and was successfully managed. 7 in the M-DALK alone and 4 in the M-DALK combined with lens surgery experienced RK incision dehiscence during the host corneal trephination or donor graft suturing, uneventfully solved by additional sutures. No cases required conversion to PKP. No postoperative complications were recorded during the follow-up. The mean postoperative AVCC was 0.23 ± 0.12 logMAR in the M-DALK alone group and 0.26 ± 0.9 logMAR in the M-DALK combined with lens surgery group (P = 0.3). The mean refractive sphere in the M-DALK alone group was -5.02 ± 3.52 D and -0.06 ± 1.18 D in the M-DALK combined with lens surgery (P < 0.0001). The postoperative refractive cylinder was -4.71 ± 2.54 D in the M-DALK alone group and -3.84 ± 1.67 D in the M-DALK combined with lens surgery group (P = 0.2).

Conclusion: Our results suggest that M-DALK surgery alone or combined with lens surgery provides a good balance between visual rehabilitation and safety, minimizing potential surgical-related complications in post-RK patients.