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.
- 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.
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