Keratoplasty graft thickness doesn’t affect long-term outcomes in patients with keratoconus, study finds

The effectiveness of keratoplasty using donor tissue is similar regardless of graft thickness, indicating that both split corneal procedures for DALK in keratoconus patients are viable options, according to a study.

In this retrospective, comparative clinical study, 103 eyes with keratoconus that underwent deep anterior lamellar keratoplasty (DALK) were analyzed. Among them, 67 eyes received thin grafts from Descemet stripping automated endothelial keratoplasty (DSAEK), while 36 eyes received thick grafts from Descemet membrane endothelial keratoplasty (DMEK). The study assessed baseline and postoperative metrics including central corneal thickness (CCT), inferior corneal thickness, uncorrected and corrected distance visual acuity, corneal astigmatism, mean keratometry, biomechanical properties, and complication rates.

Six months after surgery, the thin graft group had a CCT of 455.1 ± 43.0 μm compared to 546.7 ± 44.2 μm in the thick graft group. This difference in CCT and inferior corneal thickness persisted over the 5-year follow-up (P < 0.001). Postoperatively, both groups showed similar outcomes for uncorrected distance visual acuity, corrected distance visual acuity, astigmatism, and mean keratometry values at 36 months (P = 0.335, 0.286, 0.680, and 0.365, respectively). In addition, at the 2-year mark, the thin graft group had a significantly higher stiffness parameter at the first applanation compared to the thick graft group (P = 0.036), while other biomechanical parameters were similar.

Reference
Zhao Y, Du K, Peng R, et al. Outcomes of Donor Corneas of Different Thicknesses From Endothelial Keratoplasty in Deep Anterior Lamellar Keratoplasty for Keratoconus. Cornea. 2024;doi: 10.1097/ICO.0000000000003580. Epub ahead of print. PMID: 39010268.