Clinical Outcomes Of Novel House-Shaped Deep Anterior Lamellar Keratoplasty For Keratoconus

Published 2026 - 44th Congress of the ESCRS

Reference: PP14.02 | Type: Free paper | DOI: 10.82333/btf8-9480

Authors: Dr Seiichiro Sugita* ¹ , Dr Iichiro Sugita ¹

¹Sugita Eye Hospital,Nagoya,Japan

Purpose

Although various femtosecond laser incision profiles (mushroom, zigzag, etc.) have been proposed for corneal transplantation, none has demonstrated superior visual or refractive outcomes. Based on reports that angled graft fitting in femtosecond laser-assisted ALK reduces induced astigmatism, we developed a novel "house-shaped profile" for DALK. This study evaluates the clinical outcomes of this profile in patients with keratoconus.

Setting

Single-center, Sugita Eye Hospital, Nagoya, Japan. This was a retrospective case series.

Methods

A retrospective analysis was conducted on 21 consecutive DALK procedures performed at our institution between November 2019 and December 2024. In all cases, incisions were made in advance using the house shape profile via FSL (iFS, AMO). We analyzed 18 eyes that completed DALK, excluding 2 eyes converted to PKP due to intraoperative perforation and 1 eye requiring additional suturing due to postoperative traumatic globe rupture. We evaluated best-corrected spectacle visual acuity (BSCVA), best-corrected contact lens visual acuity (CLVA), maximum corneal curvature (Kmax), and corneal astigmatism (CYL) at baseline, 3 months postoperatively, and 3 months after suture removal (9–27 months, median 12 months).

Results

The characteristics included an average age of 49.6 ± 15.0 years, 13 male eyes/5 female eyes, Kmax of 68.8 ± 12.4 D, Amsler-Krumeich classification Stage IV in 11 eyes (61.1%), and a history of acute edema in 9 eyes (50.0%).

BSCVA and CLVA significantly improved from preoperative 0.62±0.38 to 0.16±0.27 (p<0.001) and 0.076±0.18 (p<0.001), respectively, at 3 months post-suture removal (median 12 months). Kmax decreased from 68.8±12.4D preoperatively to 47.8±2.9D at 3 months post-suture removal (median 12 months) (p<0.001).

At 3 months post-suture removal (median 12 months), corneal astigmatism (CYL) was 3.84 ± 2.58 D (median 3.43 D). CYL < 4 D was present in 13 eyes (72.2%), and CYL ≥ 7 D in 2 eyes (11%).

Conclusions

The novel house-shaped DALK demonstrated favorable visual acuity improvement and astigmatism control in keratoconus cases, including difficult ones, and was considered a useful surgical technique.