ESCRS - POCOR047 - Donut-Shaped Intrastromal Keratoplasty (Dsik) For The Correction Of Post-Penetrating Keratoplasty Ectasia (Topoplasty)

Donut-Shaped Intrastromal Keratoplasty (Dsik) For The Correction Of Post-Penetrating Keratoplasty Ectasia (Topoplasty)

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR047 | Type: Case Report | DOI: 10.82333/c19e-cy38

Authors: Dr Sandro Coscarelli* 1 , Dr Leonardo Torquetti 2

1Ennio Coscarelli Eye Clinic,Belo Horizonte,Brazil, 2Centro de Excelência em Oftalmologia,Belo Horizonte,Brazil

Purpose

To present the application of Donut-Shaped Intrastromal Keratoplasty (DSIK) as a topoplasty strategy for the correction of ectasia following penetrating keratoplasty.

Setting

Private Clinic, Belo Horizonte, Brazil

Report of case

A 45-year-old female patient underwent penetrating keratoplasty in the left eye approximately 20 years ago and subsequently developed progressive ectasia with significant visual impairment, without successful adaptation to contact lenses. On examination, corrected distance visual acuity was 20/20 in the right eye (OD: -0.50 -3.50 ×30) and 20/100 in the left eye (OS: -16.00 -7.00 ×45). Slit-lamp biomicroscopy revealed a clear penetrating graft in the left eye, with 360-degree circumferential thinning at the graft-host junction. Corneal tomography (Pentacam) demonstrated incipient keratoconus in the right eye and post-keratoplasty ectasia in the left eye. Intervention: Given the graft transparency and predominantly peripheral ectasia at the graft interface, DSIK was indicated as a topoplasty technique. The procedure consists of implanting a 360-degree ring-shaped stromal graft to promote biomechanical redistribution and corneal curvature regularization. The technique may be combined with intrastromal corneal ring segment implantation, depending on residual refractive error. Results: Postoperatively, improved topographic regularity and a significant reduction in irregular astigmatism were observed, with potential functional visual gain. No relevant intraoperative or postoperative complications occurred, and graft transparency was maintained.

Conclusion/Take home message

DSIK represents a conservative and promising surgical alternative for the management of post-penetrating keratoplasty ectasia, providing structural reinforcement and visual rehabilitation without the need for repeat transplantation.