An endeavor for excellent and aberration-free vision in advanced keratoconus: Penetrating or deep anterior keratoplasty?

Purpose: The purpose of this study was to describe the refractive outcomes and finer aspects of visual acuity such as contrast, aberrations, and quality of vision after keratoplasty for keratoconus. Design: This was a longitudinal clinical study of 50 eyes of 50 patients undergoing optical penetrating keratoplasty (OPK) or deep anterior lamellar keratoplasty (DALK). Materials and Methods: Visual acuity, slit-lamp evaluation, corneal topography, fundus evaluation, intraocular pressure measurement, contrast, and aberrometry were performed preoperatively and postoperatively at 1, 3, 6, and 12 months. The Visual Function Questionnaire-25 criteria were used to determine the quality of life. Results: Contrast sensitivity and visual acuity had significantly improved at each assessment postoperatively. There was a statistically significant improvement in the postoperative 1-year subjective visual score and maximum keratometry in both groups. In the OPK group, all aberration values showed significant improvements in the anterior and total corneal surfaces. The DALK group showed significant improvements in spherical aberration, root mean square (RMS) total, and RMS higher-order aberrations in the anterior corneal surface. The total corneal surface showed a significant improvement only in spherical aberration and RMS total values. Conclusion: From our study we conclude, that there was a statistically significant improvement in preoperative versus postoperative 1-year logMAR visual acuity, contrast sensitivity, subjective visual score, maximum keratometry, spherical aberration, and total aberrations in both OPK and DALK. OPK patients also show a statistically significant improvement in vertical coma, RMS higher-order aberration, and trefoil as compared to DALK. The selection of the surgical procedure depends on the surgeon’s preference, the patient profile, cone size, and pachymetry.