Clinical Outcomes of Modified Manual Deep Anterior Lamellar Keratoplasty for Eyes with Previous Radial Keratotomy

Background: The aim of this study was to evaluate the intraoperative complications and visual outcomes of manual deep anterior lamellar keratoplasty (mDALK) in patients who underwent previous radial keratotomy (RK) for myopia. Methods: The notes of patients who underwent mDALK after RK at three different hospitals-San Giovanni Addolorata Hospital (Rome, Italy), Mount Saint Joseph Hospital (Vancouver, Canada), and Tor Vergata University Hospital (Rome, Italy)-were retrospectively reviewed. We analyzed the manual dissection success rate and conversion to penetrating keratoplasty (PK), the residual recipient stromal thickness, the postoperative corrected distance visual acuity (CDVA), postoperative refraction, and topographic astigmatism. Results: Thirteen eyes of eleven patients were included in the analysis (male 7/11, 63.6%). Preoperatively, mean topographic astigmatism was 5.4 +/- 3.5 D (range 1.6-14.8 D), and mean CDVA was 0.47 +/- 0.2 logMAR (range 0.3-1.0 logMAR) [Snellen equivalent 20/50]. Manual dissection was performed in all cases. None of the examined eyes were converted to PK. An improvement in both topographic astigmatism (2.8 +/- 0.9 D, p = 0.0135) and CDVA (0.23 +/- 0.2 LogMAR, p = 0.0122) was recorded at 12-month follow-up. Conclusions: mDALK is a safe and effective surgical technique when applied to eyes previously treated with RK, with an observed improvement in CDVA and topographic astigmatism.