title: Comparison of astigmatic keratotomy results in deep anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus.
abstract: OBJECTIVE
  To compare astigmatic keratotomy (AK) outcomes in high astigmatism after deep anterior lamellar keratoplasty (DALK) and after penetrating keratoplasty (PK) in keratoconus patients.
  
  
  METHODS
  Prospective, comparative, interventional case series.
  
  
  METHODS
  This study comprised 20 eyes that underwent DALK and 24 eyes that underwent PK. After suture removal, all eyes had more than 5 diopters (D) of astigmatism and underwent standard manual 1-pair, 90-degree, and 90% corneal thickness AK incisions. The main outcome measures included preoperative and postoperative manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity, surgically induced astigmatism, Orbscan II (Bausch & Lomb) corneal topography results, keratometric astigmatism, and complications.
  
  
  RESULTS
  All eyes completed 6 months of follow-up. The overcorrection rate was 35% and 41.6% in the DALK and PK groups, respectively (P=.75). At 6 months after AK, logarithm of the minimal angle of resolution uncorrected visual acuity improved from 0.88 ± 0.20 to 0.54 ± 0.26 and from 1.0 ± 0.34 to 0.53 ± 0.26 in the DALK and PK groups, respectively (P=.01 to P<.01). Best spectacle-corrected visual acuity improved from 0.16 ± 0.09 to 0.13 ± 0.08 and from 0.16 ± 0.12 to 0.11 ± 0.08 in the DALK and PK groups, respectively (P=.13 to P=.01). The mean refractive cylinder was decreased 2.74 ± 1.44 D in the DALK group and 3.18 ± 2.96 D in the PK group (P=.35). Surgically induced astigmatism was 6.10 ± 3.27 D in the DALK group and 7.15 ± 2.98 D in the PK group (P=.36).
  
  
  CONCLUSIONS
  The manual AK for the treatment of postkeratoplasty astigmatism after DALK and PK in keratoconus patients is a safe and effective surgical procedure, allowing similar refractive cylinder reduction and improvement in uncorrected visual acuity and best spectacle-corrected visual acuity.
authors.affiliation: Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Anil
authors.initials: A
authors.lastname: Kubaloglu
authors.forename: Erol
authors.initials: E
authors.lastname: Coskun
authors.forename: Esin Sogutlu
authors.initials: ES
authors.lastname: Sari
authors.forename: Alime Sefer
authors.initials: AS
authors.lastname: Guneş
authors.forename: Yasin
authors.initials: Y
authors.lastname: Cinar
authors.forename: David P
authors.initials: DP
authors.lastname: Piñero
authors.forename: Isil
authors.initials: I
authors.lastname: Kutluturk
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ozerturk
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003315:Cornea / Q000503:physiopathology; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D054140:Refractive Surgical Procedures; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology