title: Refractive outcomes of penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes for keratoconus.
abstract: OBJECTIVE
  To compare the refractive outcomes following penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes in patients with keratoconus.
  
  
  METHODS
  This is an observational retrospective review of consecutive patients with keratoconus first managed with penetrating keratoplasty in one eye and then with lamellar keratoplasty in the fellow eye, between 2002 and 2007. Data collection was based on patients' hospital records. Information related to assessment before surgery and at 1, 3, 6, 12, 24, and 48 months after keratoplasty were retrieved and considered in the analysis. Clinical evaluations included patients' medical histories and diagnosis of keratoconus, uncorrected and best corrected visual acuity, spherical equivalent, refractive cylinder, topographic cylinder, and high-order aberrations, complications, and adverse reactions. Data on contrast sensitivity, central corneal thickness, and central residual bed thickness (only for lamellar keratoplasty) were retrieved from anterior segment optical coherence tomography observation performed at 48 months.
  
  
  RESULTS
  Sixteen patients (32 eyes), 7 males and 9 females, were included in the analyses. After 4 years from transplantation, at the end of follow-up, no statistically significant differences were found in visual acuity and refractive measures between the two keratoplasties. Perforating keratoplasty showed significant differences for contrast sensitivity at 6 cpd with maximum glare (p = 0.026) and without glare (p = 0.015). Deep anterior lamellar keratoplasty showed a negative correlation between central residual bed thickness and best corrected visual acuity (R = -0.414, p < 0.001).
  
  
  CONCLUSIONS
  The manual pre-descemetic deep anterior lamellar keratoplasty used in this study showed refractive and visual results comparable to those obtained with penetrating keratoplasty. Such results indicated that leaving healthy stroma attached to Descemet's membrane does not compromise the clinical outcome in the short and long term after surgery.
authors.affiliation: Department of Neurosciences, Biomedicine, and Movement Sciences, Eye Clinic, University of Verona, Ospedale Maggiore, P.Le A. Stefani 1, 37126, Verona, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Pedrotti
authors.affiliation: Department of Neurosciences, Biomedicine, and Movement Sciences, Eye Clinic, University of Verona, Ospedale Maggiore, P.Le A. Stefani 1, 37126, Verona, Italy. mattia.passilongo@yahoo.it.
authors.forename: Mattia
authors.initials: M
authors.lastname: Passilongo
authors.affiliation: Fondazione Banca degli Occhi Del Veneto (The Veneto EyeBank Foundation), Via Paccagnella, 11 Zelarino, 30174, Venice, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Fasolo
authors.affiliation: Department of Neurosciences, Biomedicine, and Movement Sciences, Eye Clinic, University of Verona, Ospedale Maggiore, P.Le A. Stefani 1, 37126, Verona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Ficial
authors.affiliation: Fondazione Banca degli Occhi Del Veneto (The Veneto EyeBank Foundation), Via Paccagnella, 11 Zelarino, 30174, Venice, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Department of Neurosciences, Biomedicine, and Movement Sciences, Eye Clinic, University of Verona, Ospedale Maggiore, P.Le A. Stefani 1, 37126, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Marchini
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology / Q000601:surgery; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D012029:Refraction, Ocular; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
keywords: Deep anterior lamellar keratoplasty; Fellow eyes; Keratoconus; Penetrating keratoplasty; Retrospective study