Astigmatism Orientation After Deep Anterior Lamellar Keratoplasty for Keratoconus and Its Correlation With Preoperative Peripheral Corneal Astigmatism

Cornea. 2020 Feb;39(2):192-195. doi: 10.1097/ICO.0000000000002175.


Purpose: To evaluate the orientation of keratometric astigmatism (KA) after deep anterior lamellar keratoplasty (DALK) for keratoconus and its correlation with preoperative peripheral KA.

Methods: This is a retrospective, single-center observational study including keratoconic patients undergoing DALK between January 2016 and January 2017 with regular astigmatism postoperatively. The orientation of postoperative KA was classified as with-the-rule (WTR), against-the-rule, or oblique and was correlated with the corresponding preoperative peripheral KA, calculated by the sinusoidal fitting of points of the axial keratometric power map at 8 mm diameter.

Results: Forty-one keratoconic eyes were included, with the most common orientation of KA post-DALK being WTR (65.9%), followed by against-the-rule (19.5%) and oblique (14.6%). A significant correlation was found between preoperative peripheral KA and post-DALK KA regarding axis (P < 0.001, r = 0.88) and power (P = 0.0128, r = 0.23).

Conclusions: The axis of post-DALK astigmatism and to a lesser extent its respective power in keratoconic eyes can be predicted using the preoperative peripheral KA, with "WTR" being the most common astigmatic orientation.

MeSH terms

  • Adult
  • Astigmatism / physiopathology*
  • Corneal Topography
  • Corneal Transplantation*
  • Female
  • Humans
  • Keratoconus / physiopathology
  • Keratoconus / surgery*
  • Male
  • Middle Aged
  • Orientation, Spatial / physiology*
  • Refraction, Ocular / physiology
  • Retrospective Studies
  • Visual Acuity / physiology
  • Young Adult