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Cornea and ocular surface
Clinical science
Keratoscope-guided opening of graft-host junction to treat elevated astigmatism after deep anterior lamellar keratoplasty
  1. Costanza Rossi1,
  2. Andrea Lucisano1,
  3. Giovanni Scalia1,
  4. Sabrina Vaccaro1,2,
  5. Giuseppe Alessio1,
  6. Andrea Taloni1,
  7. Maria Angela Romeo1,
  8. Simone Porchia1,
  9. Massimiliano Borselli1,
  10. Adriano Carnevali1,
  11. Vincenzo Scorcia1,
  12. Giovanna Carnovale-Scalzo1
  1. 1 Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
  2. 2 Department of Medical-Surgical Specialties Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  1. Correspondence to Professor Vincenzo Scorcia; vscorcia{at}unicz.it

Abstract

Aims To describe a simple surgical technique consisting of opening the vertical graft-host junction (GHJ) to manage high astigmatism following deep anterior lamellar keratoplasty (DALK) and to report postoperative visual and topographic outcomes.

Methods This is a retrospective interventional case series. Patients affected by high astigmatism after DALK underwent progressive opening of the previous GHJ at the steep meridians, established with preoperative topography and intraoperative keratoscopic guidance. Evaluations were carried out with best corrected visual acuity (BCVA), refractive astigmatism (RA) and keratometric astigmatism (KA) measured with Casia (Tomey, Japan). Visits were conducted preoperatively (T0), 1 week (T1), 6 months (T2) and 1 year after surgery (T3). The Alpins Method was used to evaluate vectorial changes in KA between T0 and T3.

Results Fifteen patients were included in the analysis. BCVA (median (IQR)) increased significantly from 0.70 (0.5–1.1) at T0 to 0.20 (0.1–0.3) logMAR at T3 (p=0.001). RA (mean±SD) at T3 was 2.28±1.59 dioptres (D). KA (mean±SD) varied significantly from 8.04±2.14 D at T0 versus 2.93±1.94 D at T1 versus 3.15±1.79 D at T2, versus 3.23±1.63 D at T3 (p<0.0001). Vectorial analysis showed that target induced astigmatism (mean±SD) was 8.04±2.14 D, while surgically induced astigmatism (mean±SD) was 7.89±4.27 D. Correction index (mean±SD) was 0.92±0.33.

Conclusions High astigmatism after DALK can be safely and effectively managed by opening the GHJ down to the cleavage plane achieved with the previous surgery, providing low KA and RA, with an overall low tendency to overcorrection.

  • Cornea
  • Treatment Surgery

Data availability statement

Data are available upon reasonable request. For data requests contact: vscorcia@unicz.it.

https://doi.org/10.1136/bjo-2025-327208

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    Data availability statement

    Data are available upon reasonable request. For data requests contact: vscorcia@unicz.it.

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    Footnotes

    • CR and AL contributed equally.

    • Contributors Conceptualisation: CR, AL, VS and GCS. Methodology: CR, AL, VS and GCS. Validation: AL, VS and GCS. Formal analysis: CR, SV, AT, MB, SP and GS. Investigation: CR, GS, SV, SP, AT, MB, GA, MAR, SP and AC. Data curation: CR, GS, SV, GA, MAR, MB and AC. Writing – original draft preparation: CR, AL, MB, AT and SV. Writing – review and editing: CR, AL, VS and GCS. Visualisation: CR, AL, AT, GS, GA, SP, MAR, AC, MB, SV and VS. Supervision: AL, VS and GCS. Project administration: AL, VS and GCS. VS is the guarantor for this work.

    • 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.

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