Five-Year Results Of Deep Anterior Lamellar Keratoplasty For Keratoconus Versus Post-Herpetic Stromal Scarring
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR200 | Type: Free paper | DOI: 10.82333/qwqr-qp50
Authors: Dr Linda Marie Louise Busin* 1 , Dr Andrea Taloni 1 , Dr Rossella Spena 1 , Raphael Kilian 1 , Dr Valentino De Ruvo 1 , Dr Andrea Sollazzo 1 , A/Prof. Cristina Bovone 1 , Dr Niccolò Salgari 1 , Dr Nicolò Ciarmatori 1 , A/Prof. Massimo Busin 1
1Department of Translational Medicine, University of Ferrara; Department of Ophthalmology, Ospedali Privati Forlì "Villa Igea"; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia,University of Ferrara; Ospedali Privati Forlì ''Villa Igea'',Ferrara, Forlì,Italy
Purpose
To compare the outcomes of deep anterior lamellar keratoplasty (DALK) in eyes with post-herpetic corneal leukoma versus keratoconic eyes.
Setting
Patients underwent keratoplasty at the department of ophthalmology of “Villa Igea”, Ospedali Privati Forlì (Forlì, Italy) between May 2012 and December 2024.
Methods
This is a retrospective cohort study based on prospectively collected data from consecutive cases. All included patients received large-diameter (9-mm) big-bubble DALK. If pneumatic dissection failed, layer-by-layer manual dissection was performed. Patients were excluded from the analysis if they underwent previous ocular surgery, except uneventful cataract surgery and cross-linking, or in case of pre-existing vision-impairing comorbidities. Primary outcomes were best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), refractive astigmatism, and graft survival rates.
Results
All consecutive eyes that underwent DALK at our Institution between 2012 and 2024 were assigned according to the indication to either group 1 (keratoconus, n=809) or group 2 (post-herpetic leukoma, n=108). Mean follow-up was 4.6±3.0 years (up to 12 years). At 5 years postoperatively, BCVA was significantly better in group 1 (0.09±0.17 vs 0.23±0.27 LogMAR; P=0.002); ECD was significantly higher in group 1 (1897±457 vs 1581±477 cells/mm 2 ; P=0.005), with lower ECL (13.9±20.9% vs 28.2±21.5%; P=0.005); refractive astigmatism did not differ significantly between groups (2.79±1.49 vs 3.17±1.22 D; P=0.303). Graft survival rates were 99.0% and 97.5%, respectively in the two groups (P=0.007).
Conclusions
The findings of this study indicate that DALK can achieve excellent results independently of the type of indication, in both inflammatory and non-inflammatory stromal diseases. Postoperative ECD and ECL were significantly worse in post-herpetic eyes than in keratoconic eyes, but still within values compatible with long-term graft survival and satisfactory visual acuity.