title: Outcomes of deep anterior lamellar keratoplasty versus intralase enabled penetrating keratoplasty in keratoconus.
abstract: OBJECTIVE
  To compare the visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) and intralase enabled keratoplasty (IEK) for keratoconus.
  
  
  METHODS
  A retrospective comparative case series.
  
  
  METHODS
  Eighteen eyes that underwent DALK and 18 that had IEK for keratoconus.
  
  
  METHODS
  Main outcome measures included preoperative and postoperative best spectacle corrected visual acuity (BSCVA), refraction, high-order aberrations (HOA), and complication rate were compared between the 2 groups after all suture removals.
  
  
  RESULTS
  Mean time to all suture removal was 11.91 months for the DALK and 6.7 months for the IEK. The mean logMAR BSCVA of patients in the DALK group was 0.28 (20/38) and 0.37 (20/46) in the IEK group (p < 0.211). The final sphere was -5.62 and -0.53 in the DALK and IEK groups, respectively (p < 0.973). There was statistically significant difference in the astigmatism between the 2 groups with mean manifest cylinder of 3.13 in the DALK group and 5.78 in the IEK group (p < 0.011).Total HOA (DALK 6.11 vs IEK 9.32, p < 0.036) and total spherical aberrations (DALK 0.44 vs IEK 0.71, p < 0.041) were both significantly higher in the IEK group. A total of 44.4% of eyes underwent astigmatic keratotomy after IEK compared to 5.6% of eyes in the DALK group (p < 0.018; odds ratio = 13.6 [1.48, 125.31]). Overall complication rates were similar for DALK and IEK groups.
  
  
  CONCLUSIONS
  BSCVA and complication rates are similar after DALK and IEK, but each technique has its advantage. IEK offered shorter time to suture removal whereas DALK offered lower postoperative astigmatism and HOA rates.
authors: Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ontario. Raneen_sh_mash@hotmail.com
authors: Raneen Shehadeh
authors: RS
authors: Mashor
authors: Dan B
authors: DB
authors: Rootman
authors: Irit
authors: I
authors: Bahar
authors: Neera
authors: N
authors: Singal
authors: Allan R
authors: AR
authors: Slomovic
authors: David S
authors: DS
authors: Rootman
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000503:physiopathology; D016039:Corneal Transplantation; D057108:Corneal Wavefront Aberration / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D054018:Lasers, Excimer / Q000627:therapeutic use; D008297:Male; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*