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Ten-year outcomes of microkeratome-assisted lamellar keratoplasty for keratoconus
  1. Angeli Christy Yu1,2,3,
  2. Elena Franco1,2,
  3. Lorenzo Caruso4,
  4. James Myerscough2,3,5,
  5. Rossella Spena1,2,3,
  6. Fiorella Fusco2,3,
  7. Sergiu Socea2,3,
  8. Cristina Bovone1,2,3,
  9. Massimo Busin1,2,3
  1. 1 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
  2. 2 Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
  3. 3 Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
  4. 4 Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
  5. 5 Department of Ophthalmology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
  1. Correspondence to Massimo Busin, Department of Ophthalmology, Ospedali Privati Forlì ‘Villa Igea’, Forlì 47122 Italy; mbusin{at}


Background/Aims To report the 10-year outcomes of modified microkeratome-assisted lamellar keratoplasty (LK) for keratoconus.

Methods In this single-centre interventional case series, 151 consecutive eyes with keratoconus underwent modified microkeratome-assisted LK. Eyes with scars extending beyond the posterior half of the corneal stroma and preoperative thinnest-point pachymetry value of less than 300 μm were excluded. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density, immunological rejection, ectasia recurrence and graft failure rates.

Results Baseline BSCVA (0.89±0.31 logarithm of the minimum angle of resolution (logMAR)) significantly improved to 0.10±0.12 logMAR at year 3 (p<0.001), and remained stable up to 10 years. At 10 years, 94% of eyes saw ≥20/40, 61% saw ≥20/25 and 24% saw ≥20/20 Snellen BSCVA. At final follow-up, RA exceeding 4.5 dioptres was observed in 5 cases (4%). Endothelial cell loss was 25±17% at 1 year with an annual decline of 2% over 10 years. The 10-year cumulative risk for immunological rejection and graft failure was 8.5%, and 2.4%, respectively. No case developed recurrent ectasia at 10 years.

Conclusion Modified microkeratome-assisted LK results in stable visual and refractive outcomes with low rates of immunological rejection and graft failure in the absence of recurrence of ectasia for at least 10 years.

  • Cornea
  • Treatment Surgery

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  • Contributors Concept and design of the study: ACY and MB. Data acquisition: ACY, EF, LC, RS, FF, SS and CB. Data analysis/interpretation: ACY, JM and MB. Drafting of the manuscript: ACY, LC, JM, RS, FF, SS and CB. Critical revision of the manuscript: ACY, JM and MB. Statistical analysis: ACY. Final approval: ACY, EF, LC, JM, RS, FF, SS, CB and MB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval for this study was obtained from the Comitato Etico of Ospedali Privati Forlì, Forlì, Italy (CEOPF2004-18).

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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