Graft Refractive Surgery for Post-DALK Atigmatism in Keratoconus

Evaluate the effect of relaxing incision and adjustment sutures to correct astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. This interventional case series included keratoconic eyes undergoing graft refractive surgery (GRS) for intolerable post-DALK astigmatism. The technique of graft refractive surgery for the 5 initial cases consisted of relaxing incisions at the steep meridian in the graft-host interface down to Descemet’s membrane. The main outcomes were uncorrected and best-corrected visual acuity, and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Fourteen eyes of 14 keratoconic patients (12 male subjects) with history of DALK underwent GRS. Mean age of the patients was 29.36±6.2 years and mean follow-up period was 12.0±7.4 months after initial GRS. Mean preoperative BCVA was 0.29±0.1 logMAR which improved to 0.22±0.1 logMAR after the operation (P=0.007). Average keratometric astigmatism was reduced by 3.8 D and 5.5 D as measured by subtraction and vector analysis methods, respectively. Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus