Role of Superficial Anterior Lamellar Keratoplasty in the Treatment of Corneal Disease: Long-term Outcomes.

Purpose

To evaluate the long-term outcomes of superficial anterior lamellar keratoplasty (SALK) across a broad range of surgical indications.

Methods

This is a retrospective interventional case series including consecutive eyes undergoing SALK, regardless of the indication. Outcomes included best spectacle-corrected visual acuity and refractive astigmatism at 6 months, 1 year, and annually through 5 years. Secondary outcomes included topographic astigmatism at 5 years, graft survival, and postoperative complications.

Results

In total, 132 eyes from 132 patients were included, with a mean follow-up of 60.9 ± 48.5 months (60 and 12 eyes had 5-, and 10-year postoperative follow-up, respectively). Mean best spectacle-corrected visual acuity improved from 0.74 ± 0.50 logarithm of the minimum angle of resolution preoperatively to 0.10 ± 0.10 logarithm of the minimum angle of resolution 5 years postoperatively (P < 0.001). Surgical indication was not associated with visual outcomes (P = 0.815). Mean refractive astigmatism remained stable over time, measuring 2.65 ± 1.35 diopters (D) at 1 year, 2.00 ± 1.29 D at 3 years, and 2.52 ± 1.51 D at 5 years after surgery. Kaplan-Meier graft survival at 1, 3, 5, and 10 years was 93%, 92%, 86%, and 67%, respectively. Compared with corneal dystrophy, other indications showed lower risk of graft failure (HR: 0.32, 95% confidence interval: 0.14-0.78). Complications included graft dislocation (2.3%), epithelial ingrowth (1.5%), and interface infection (1.5%).

Conclusions

SALK provides effective and sustained visual rehabilitation for anterior stromal corneal pathology unsuitable for phototherapeutic keratectomy yet not requiring deep anterior lamellar keratoplasty, with favorable long-term outcomes.