ESCRS - PP14.15 - Donut-Shaped Intrastromal Keratoplasty – A Variant Of Cairs As An Alternative To Dalk In Advanced Keratoconus

Donut-Shaped Intrastromal Keratoplasty – A Variant Of Cairs As An Alternative To Dalk In Advanced Keratoconus

Published 2025 - 43rd Congress of the ESCRS

Reference: PP14.15 | Type: Free paper | DOI: 10.82333/dvx8-0930

Authors: AKANKSHA SHARMA* 1 , SRI GANESH 1 , SUPRIYA SRIGANESH 1 , SAVIO PEREIRA 1

1NETHRADHAMA SUPERSPECIALITY EYE HOSPITAL,BENGALURU,India

Purpose

To describe the promising outcomes of a new selective corneal stromal transplantation technique for keratoconus treatment, donut-shaped intrastromal keratoplasty (DSIK)

Setting

Ennio Coscarelli Eye Clinic - Private Practice - Belo Horizonte - Brazil

Methods

A donut-shaped corneal graft is obtained using a double-bladed trephine. The Descemet, endothelium, epithelium, and Bowman membrane are all removed from the graft. Only stromal tissue is transplanted. Using the femtosecond laser, a wide 360-degree intrastromal tunnel is created with a 30-degree angulation. The diameter ranged from 5.4 mm to 8 mm optical zone. After dehydration, the corneal graft is inserted into the tunnel. We report the clinical and tomographic outcomes after the procedure in 23 eyes of 19 patients. We evaluated the preoperative and postoperative uncorrected distance visual acuity (UDVA) LogMar, corrected distance visual acuity (CDVA) LogMar, spherical equivalent and keratometry.

Results

The mean preoperative UDVA improved from 1.25 to 0.86 after DSIK; preoperative CDVA was 0.59 and improved to 0.43 after DSIK. The mean spherical value reduced from - 8,22 preoperatively to 0,40 after DSIK. The mean cylindrical value reduced from 3,62 preoperatively to 2,86 after DSIK. The mean spherical equivalent reduced from -10.03 preoperatively to -1,96 after DSIK. The mean flat keratometry (K1) reduced from 48,12 D preoperatively to 41,36 D, the mean steep keratometry (K2) reduced from 51,32 D preoperatively to 43,91 D, and the mean maximum keratometry (Kmax) reduced from 56 D preoperatively to 42,60 D postoperatively.

 

 

Conclusions

DSIK is a variation of Corneal Allogenic Intrastromal Ring Segments (CAIRS) and has been shown to be a safe and effective option for keratoconus treatment, especially in moderate to advanced cases with a central clear cornea without scars. The technique is minimally invasive, and the visual axis remains untouched.