Impact Of Residual Stromal Thickness On The Outcomes Of Manual Deep Anterior Lamellar Keratoplasty
Published 2024 - 42nd Congress of the ESCRS
Reference: FP31.10 | Type: Free paper | DOI: 10.82333/96c8-5274
Authors: Andrea Taloni* 1 , Luca Bifezzi 1 , Sabrina Vaccaro 1 , Massimiliano Borselli 1 , Costanza Rossi 1 , Alessandra Mancini 1 , Maria Angela Romeo 1 , Giuseppe Alessio 1 , Giovanna Carnovale Scalzo 1 , Vincenzo Scorcia 1 , Andrea Lucisano 1
1Department of Ophthalmology,University Magna Graecia of Catanzaro,Catanzaro,Italy
Purpose
To analyze how postoperative outcomes of manual deep anterior lamellar keratoplasty (DALK) are influenced by the thickness of the residual stromal bed of the recipient, and to explore predictive factors for this parameter.
Setting
Patients affected by keratoconus underwent manual DALK between September 2011 and January 2022 by the same experienced surgeons (V.S. and A.L.) at “Magna Graecia” University of Catanzaro, Italy.
Methods
This is a retrospective case series. Best spectacle-corrected visual acuity (BSCVA) and tomographic parameters were evaluated preoperatively (T0) and postoperatively after complete suture removal (1 year, T1). The residual stromal bed of the recipient at T1 was assessed using the “flap thickness” module of CASIA SS-1000 optical coherence tomography (Tomey, Tokyo, Japan). Measurements were performed at the center of the graft and at 12 peripheral points, 2 mm inside the margin of the corneal graft, along 6 different meridians equally spaced at 30 degrees. Then, mean peripheral thickness was calculated.
Results
Data from 40 eyes undergone manual DALK were evaluated. BSCVA significantly improved at T1 (1.09±0.55 LogMAR [95% CI, 0.91-1.26] vs 0.17±0.17 LogMAR [95% CI, 0.11-0.22]). A significant linear correlation was found between postoperative BSCVA and mean apical thickness of the residual stromal bed (71.35±27.34 µm [95% CI, 62.54-80.16]; r=0.50, p=0.002); conversely, the correlation with mean peripheral thickness of the residual stromal bed was not significant (77.79±25.49 µm [95% CI, 69.57-86]; r=0.28, p=0.09). Multivariate regression analysis found mean posterior and anterior keratometry (K) readings of the axial power map to be the strongest predictive factors for the apical thickness of the residual stromal bed (R2=0.32, p<0.001).
Conclusions
Postoperative BSCVA is significantly correlated with the apical thickness of the residual stromal bed. The preoperative mean posterior and anterior K readings may be predictors of the postoperative apical thickness of the residual stromal bed.