DALK or PKP? ‐ Surgical management of keratoconus

Abstract

AbstractSince 2010, more than 1300 patients have been registered in our Homburg Keratoconus Center HKC. Major objectives include (1) aetiology, (2) earliest diagnosis and (3) stage‐related treatment options. Excimer laser assisted DALK is a good option for skilled microsurgeons in case of good endothelium and lack of predescemetal scars offering visual acuity results of 20/25 or 20/20 when Descemet membrane is indeed exposed. In case of nonexposure of Descemet membran and/or in case of perforation conversion to excimer laser assisted PKP can be performed readily without disadvantages for the typically young patient.Central round 8.0 or 8.5 mm excimer laser assisted PKP with double‐diagonal cross‐stitch suture is still state‐of‐the‐art in advanced keratoconus – especially after corneal hydrops. Nonmechanical excimer laser trephination results in (1) lower astigmatism, (2) higher regularity of topography and (3) better visual acuity. In contrast, femtosecond laser assisted PKP demanding applanation and deformation of the cone during suction, results in decentration and noncongruent shapes of donor and host intraoperatively as well as very high astigmatism after entire suture removal – thus to be considered the „excitement of yesterday“.