ESCRS - FP30.14 - Corneal Tissue Addition Keratoplasty In Keratoconus: A Retrospective Multi-Center Analysis

Corneal Tissue Addition Keratoplasty In Keratoconus: A Retrospective Multi-Center Analysis

Published 2026 - 44th Congress of the ESCRS

Reference: FP30.14 | Type: Free paper | DOI: 10.82333/5tgf-qy64

Authors: Dr Brandon Ayres* 1 , Dr Suzanne Kirk 2 , Dr William Wiley 2 , Dr John Berdahl 3 , Dr Nicole Fram 4

1Ophthalmology,Wills Eye Hospital,Philadelphia,United States, 2Ophthalmology,Cleveland Eye Clinic,Brecksville,United States, 3Ophthalmology,Vance Thompson Vision,Sioux Falls,United States, 4Ophthalmology,Advanced Vision Care,Los Angeles,United States

Purpose

To evaluate the visual and refractive outcomes following Corneal Tissue Addition Keratoplasty (CTAK) in patients with corneal ectatic disorders, using data collected from four high volume surgical centers.

Setting

This retrospective, multicenter study included 63 eyes that underwent CTAK between March 2023 and December 2025. Data from four high volume surgical centers were analyzed at postoperative months 1, 3, and 6. 

Methods

Data was pooled from 4 clinical sites (Cleveland Eye Clinic, Willis Eye Hospital, Vance Thompson Vision, Advanced Vision Care). Preoperative and 1-month post-operative (POM1) evaluations included uncorrected (scVA) and best-corrected visual acuity (bcVA) in logMAR, anterior corneal cylinder on Scheimpflug tomography (Pentacam), keratometric mean (Kmean), and manifest refraction spherical equivalent (MRSE). Primary endpoints were changes from baseline to POM1 in scVA, bcVA, and Kmean; secondary endpoints included changes in anterior corneal cylinder and MRSE. Continuous variables are reported as mean±SD; paired comparisons used two-sided paired t-tests with α=0.05.

Results

  • scVA (logMAR) at POM1 improved from 1.04±0.52 to 0.49±0.31 (Δ=-0.55, 95% CI -0.73 to -0.37, p=0.00; n=30).
  • bcVA (logMAR) at POM1 changed from 0.40±0.29 to 0.16±0.16 (Δ=-0.23, 95% CI -0.31 to -0.16, p=0.00; n=53).
  • Kmean (D) flattened from 51.94±8.43 to 49.90±9.01 (Δ=-2.04 D, 95% CI -3.12 to -0.96, p=0.00; n=50).
  • Anterior corneal cylinder (Pentacam, D) changed from 4.53±2.64 to 4.40±3.23 (Δ=-0.13 D, 95% CI -0.88 to 0.62, p=0.73; n=48).
  • Manifest spherical equivalent (D) shifted from -4.66±4.80 to -2.10±4.02 (Δ=2.56 D, 95% CI 1.36 to 3.76, p=0.00; n=43).

Conclusions

CTAK demonstrated promising short‑term outcomes across multiple centers, contributing to improved visual acuity and corneal regularization in ectatic patients. At 6 months, preliminary analysis showed significant improvement in mean UCVA and BCVA compared to baseline, with concurrent flattening in mean keratometry values. The majority of eyes demonstrated stable refractive and topographic outcomes across visits. Early postoperative complications were limited and self-resolving, without requiring additional surgical intervention. No cases of graft rejection or visually significant haze were reported within the follow-up period.