ESCRS - PO0724 - High Astigmatism Following Conventional Diameter Dalk In Keratoconus Can Be Successfully Managed With Repeat Wide Diameter Dalk

High Astigmatism Following Conventional Diameter Dalk In Keratoconus Can Be Successfully Managed With Repeat Wide Diameter Dalk

Published 2023 - 41st Congress of the ESCRS

Reference: PO0724 | Type: Free paper | DOI: 10.82333/69tc-1e70

Authors: Jesse Panthagani* 1 , Elizabeth Law 1 , Chimwemwe Chipeta 1 , Harry Roberts 2 , James Myerscough 1

1Southend University Hospital,Southend-on-Sea,United Kingdom, 2West of England Eye Unit,Exeter,United Kingdom

Purpose

To describe a new surgical technique to replace a conventional diameter (≤8mm) deep anterior lamellar keratoplasty (DALK) graft with associated high astigmatism refractory to corneal based astigmatic procedure/intolerance to contact lenses with a larger diameter (≥9mm) DALK graft in order to improve best spectacle-corrected visual acuity (BSCVA).

Setting

Southend University Hospital, Mid and South Essex NHS Foundation Trust.

Methods

2 eyes from 2 keratoconic patients at Southend University Hospital between December 2019 and June 2021 with a minimum follow-up of 17 months were evaluated. The primary outcome of interest was Snellen BSCVA with a secondary outcome of topographic cylinder.

Results

Patient 1 had an initial 8mm diameter DALK, with residual keratometric astigmatism of nearly 12 diopters (D) postoperatively despite numerous astigmatic interventions, with a BSCVA of 6/60, before undergoing 9mm diameter repeat modified DALK. After suture removal and subsequent in-the-wound blunt manual relaxing incisions, the patient had a final keratometric astigmatism of 3.5D, manifest refraction of plano/-3.50 x 175 and a BSCVA of 6/9.

Patient 2 had an initial 7.75mm diameter DALK, with residual keratometric astigmatism of 10.5D with a BSCVA of counting fingers (CF). They underwent 9mm repeat modified DALK with final residual keratometric astigmatism of 3.1D after suture removal, manifest refraction of -1.00/-2.75 x 25 and BSCVA of 6/9.

Conclusions

Wide diameter DALK (>9mm) is effective in the management of conventional diameter DALK (≤8mm) associated high astigmatism in keratoconus. Creation of a peripheral posterior stromal shoulder also allows safe further titration of residual astigmatism if needed.