title: Long-term clinical outcomes of deep anterior lamellar keratoplasty in patients with keratoconus.
abstract: OBJECTIVE
  To report long-term clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.
  
  
  METHODS
  Retrospective noncomparative interventional study.
  
  
  METHODS
  setting: Single center. patients: Total of 158 eyes/150 consecutive patients with keratoconus with postoperative follow-up time equal to or greater than 4 years. intervention: DALK. main outcome measure(s): Uncorrected and corrected distance visual acuity (UDVA, CDVA), mean refractive spherical equivalent (MRSE), keratometry, endothelial cell density (ECD).
  
  
  RESULTS
  Mean postoperative follow-up was 76.9 ± 23.2 (range 48-120) months. Preoperative UDVA was 20/400 (1.5 ± 0.4 logMAR), CDVA 20/50 (0.7 ± 0.2 logMAR), MRSE -11.1 ± 5.6 diopters (D), mean keratometry 60.7 ± 6.1 D, topographic astigmatism 4.7 ± 2.6 D. At last postoperative follow-up visit, UDVA improved to 20/50 (0.5 ± 0.3 logMAR), CDVA to 20/25 (0.09 ± 0.1 logMAR), MRSE to -2.6 ± 3.5 D, mean keratometry to 44.4 ± 2.2 D, and topographic astigmatism to 2.9 ± 1.3 D. Postoperative ECD did not vary from preoperative values being 2070.5 ± 367.5 cell/mm(2) and 2198 ± 373 cell/mm(2), respectively, with 70% of eyes (111/158) showing ECD ≥2000 cells/mm(2). Eighteen eyes (11.3 %) developed stromal or epithelial rejection, 3 (1.8%) required regrafting. Eyes with successful big bubble showed greater CDVA than those that required manual dissection at follow-up equal to or less than 5 years but comparable results in the longer term.
  
  
  CONCLUSIONS
  DALK provides stable long-term visual and refractive outcomes. Risk of graft rejection, postoperative complication, and late ECD decay is reduced when compared to standard penetrating keratoplasty.
authors.affiliation: Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy. Electronic address: vito.romano@gmail.com.
authors.forename: Vito
authors.initials: V
authors.lastname: Romano
authors.affiliation: Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iovieno
authors.affiliation: Eye Unit, Ospedale Maggiore, Bologna, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Parente
authors.affiliation: Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Soldani
authors.affiliation: Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fontana
mesh_terms: D000328:Adult; D002452:Cell Count; D015897:Comorbidity; D063171:Corneal Pachymetry; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult