Paired-Eye Analysis Of Deep Anterior Lamellar Keratoplasty Versus Mushroom Penetrating Keratoplasty Over 5 Years
Published 2026 - 44th Congress of the ESCRS
Reference: FP18.10 | Type: Free paper | DOI: 10.82333/cxfv-tb54
Authors: Dr Luigi De Rosa* 1 , Dr Andrea Taloni 1 , Dr Raphael Kilian 1 , Dr Georgiana Camburu 1 , Dr Valentino De Ruvo 1 , Dr Nicolò Ciarmatori 1 , Dr Rossella Spena 1 , Dr Linda Marie Louise Busin 1 , Prof. Cristina Bovone 1 , Dr Angeli Christy Yu 1 , Dr Niccolò Salgari 1 , Prof. Massimo Busin 1
1Università degli studi di Ferrara,Ferrara,Italy
Purpose
To evaluate and compare the clinical outcomes of keratoconic patients who received deep anterior lamellar keratoplasty (DALK) in one eye and mushroom penetrating keratoplasty (MK) in the fellow eye.
Setting
Retrospective interventional case series based on prospectively collected data.
Keratoconic patients who underwent keratoplasty at the department of ophthalmology of "Villa Igea", Ospedali Privati Forlì (Forlì, Italy) between July 2006 and December 2023.
Patients underwent DALK in one eye and converted MK from intended DALK in the fellow eye.
Methods
The primary outcomes were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, and endothelial cell density (ECD). Kaplan-Meier curves were drawn for both DALK and MK to compare the cumulative probability of obtaining a BSCVA <0.3 LogMAR (Snellen 20/40) within the end of follow-up.
Results
We included 46 keratoconic patients. Mean follow-up was 5.4±2.1 years. During the first 2 years after surgery, BSCVA was significantly better in the DALK group (0.08±0.11 vs 0.15±0.20 LogMAR, P=0.05); however, no significant differences between groups were found at later follow-up times. At 5 years, BSCVA values were 0.08±0.10 and 0.12±0.18 LogMAR, respectively for DALK and MK (P=0.305). The 5-year probability of retaining a BSCVA <0.3 LogMAR was 85.1% and 83.0%, respectively for DALK and MK (P=0.791). Three years postoperatively, refractive astigmatism was significantly lower for DALK (at 5 years, 2.37±1.21 D vs 2.97±1.13 D; P=0.04). At 5 years postoperatively, ECD was 1837±625 cells/mm² for DALK and 1083±378cells/mm² for MK (P<0.001).
Conclusions
This study allowed direct intra-patient comparison between DALK and MK. Compared with MK, our findings showed for DALK better BSCVA during the first 2 years after surgery, lower refractive astigmatism from 3 years postoperatively on, and higher ECD at all time points.