Long-Term Outcomes Of Manual Arcuate Keratotomy With Compression Sutures After Penetrating And Anterior Lamellar Keratoplasty
Published 2026 - 44th Congress of the ESCRS
Reference: PP08.09 | Type: Free paper | DOI: 10.82333/xv5y-kv81
Authors: Dr Matteo Ripa* 1 , Dr Eleanor Palmer 1 , Mr Tariq Mohammad 1 , A/Prof. Dalia Said 1 , A/Prof. Harming Singh Dua 2
1Department of Ophthalmology,Queen’s Medical Centre,Nottingham,United Kingdom, 2Department of Ophthalmology,Queen’s Medical Centre,Nottingham,United Kingdom;b Academic Ophthalmology, Mental Health and Clinical Neurosciences, School of Medicine,University of Nottingham,Nottingham,United Kingdom
Purpose
To evaluate and compare the long-term functional and refractive outcomes, as well as astigmatic magnitude and axis stability, following manual astigmatic keratotomy (AK) with compression sutures in eyes with post-penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) astigmatism.
Setting
Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Methods
The medical records and corneal tomography images of patients who underwent AK with compression sutures following PKP or DALK over the past five years were reviewed and analyzed. Data at three time points (preoperative, 6 months, and last follow-up [≥12 months]), including uncorrected and best-corrected distance visual acuity (UDVA and BCVA), keratometric parameters (flat [K1], steep [K2], and mean keratometry [Km]) derived from the anterior central 3-mm zone, topographic astigmatism magnitude, and astigmatic axis were evaluated. Outcomes were compared between post-PKP and post-DALK eyes undergoing AK. Axis stability and refractive changes were also analyzed.
Results
24 eyes of 22 patients were included. Median logMAR UDVA improved significantly in both groups: PKP group improved from 1.00 preoperatively to 0.70 at last follow-up (p=0.02), and DALK group from 1.00 to 0.72 (p=0.02). At 6 months, the DALK group had significantly better UDVA than PKP (p = 0.02). In the PKP group, median K2 decreased significantly over time (p=0.02), with a significant reduction between preoperative and last follow-up values (p=0.02), while K1 remained stable. In the DALK group, K2 did not change significantly, whereas K1 increased significantly over time (p=0.03). Topographic astigmatism decreased significantly in both groups, from 13.75 D to 8.20 D in the PKP group (p=0.04) and from 9.15 D to 3.10 D in the DALK group.
Conclusions
Manual arcuate keratotomy with compression sutures provides effective and sustained reduction of post-keratoplasty astigmatism after both PKP and DALK, with good axis stability. While both procedures achieved comparable long-term refractive outcomes, visual recovery occurred earlier in DALK eyes.