An analysis of factors associated with graft topographic outcomes after deep anterior lamellar keratoplasty
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ORIGINAL PAPER
An analysis of factors associated with graft topographic outcomes after deep anterior lamellar keratoplasty Sepehr Feizi
. Maryam Najafi . Saeed Rahmani . Mohammad Ali Javadi
Received: 24 March 2020 / Accepted: 12 May 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To investigate the correlations between preoperative, operative, and postoperative factors and corneal graft topographic parameters after deep anterior lamellar keratoplasty (DALK) performed in keratoconus-affected eyes. Methods This prospective, interventional study enrolled 44 eyes. Graft topographic parameters, including keratometric astigmatism and the surface regularity index (SRI), were assessed after complete suture removal. Univariate analyses were used to evaluate the effects of preoperative factors (donor quality, donor and recipient age, keratoconus severity), operative factors (graft size, donor button roundness, roundness and centration of the donor-recipient junction), and postoperative factors (time point of suture removal) on postoperative topographic parameters. Results The roundness of the donor-recipient junction after complete suture removal had a significant association with the roundness of the donor button
S. Feizi (&) M. Najafi S. Rahmani M. A. Javadi Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St., Pasdaran Ave., Tehran 16666, Iran e-mail: [email protected] S. Rahmani Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
after trephination (P = 0.04) and the amount of graft decentration relative to the limbus (P = 0.03). A significant correlation was found between the value of graft decentration relative to the limbus and postoperative keratometric astigmatism (P = 0.001) and between the roundness of the donor-recipient junction and the postoperative SRI (P = 0.02). The flat axis of the keratometric astigmatism and the longer axis of the graft lay in the direction of graft displacement. Other investigated factors had no significant association with postoperative topographic indices. Conclusion Graft displacement relative to the limbus and roundness of the donor-recipient junction were the main predictors of graft astigmatism and regularity, respectively, after DALK. Noncircularity of the donor button after trephination could increase the graft surface irregularity indirectly by influencing the roundness of the surgical wound. Keywords Keratoconus Deep anterior lamellar keratoplasty Astigmatism Graft topography Determinant factors
Introduction Corneal graft astigmatism is the main challenge for both patients and surgeons and continues to pose a significant hindrance to visual recovery in otherwise
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Int Ophthalmol
clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). Corneal graft astigmatism is multifactorial in its etiology, and the underlying factors can be divided
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