Deep anterior lamellar keratoplasty for keratectasia after laser in situ keratomileusis

PURPOSE: To assess the efficacy of deep anterior lamellar keratoplasty (DALK) for treating post-LASIK keratectasia. SETTING: Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. DESIGN: Retrospective interventional cases series. METHODS: The same surgeon performed all DALK procedures using the Me Iles manual technique. The preoperative and postoperative corrected distance visual acuity (CDVA), spherical equivalent (SE) refraction, keratometry (K) readings, and endothelial cell profiles were compared. RESULTS: The cohort comprised 20 eyes of 18 patients (72% women) with a mean age of 29 years +/- 4 (SD). The mean follow-up was 31.8 +/- 17.0 months (range 6 to 60 months). The mean Snellen CDVA improved significantly from 20/191 before DALK to 20/23 after DALK (P < .001). The mean of the modulus of SE refraction was 11.9 +/- 6.6 diopters (D) and 11.4 +/- 4.3 D, respectively (P = .446). The mean K value was 52.2 +/- 7.0 D before DALK and 46.0 +/- 1.9 D after DALK (P = .001); the mean apical K value, 59.5 +/- 5.1 D and 49.9 +/- 2.8 D, respectively (P < .001); and the mean keratometric astigmatism, 4.3 +/- 2.4 D and 1.9 +/- 1.2 D, respectively (P = .003). The endothelial cell profile did not change significantly, and no major complications related to DALK occurred. Twelve eyes had additional refractive procedures to correct residual ametropia. CONCLUSION: Deep anterior lamellar keratoplasty using the Melles manual technique was effective and safe in restoring CDVA in patients with post-LASIK keratectasia; however, high residual ametropia was a common finding.