To compare visual acuity, refraction, and complications following deep anterior lamellar keratoplasty (DALK) using cryopreseved donor corneas to outcomes following penetrating keratoplasty (PK) and DALK using fresh donor grafts in keratoconus patients.

Sixty-one patients with moderate to advanced keratoconus who underwent corneal transplantation were enrolled. DALK was performed using the big-bubble technique yielding a bared Descemet’s membrane for all cases. DALK used either fresh or cryopreserved corneal tissues as donor grafts. Clinical outcomes and postoperative complications were compared between the study groups.

Eighteen (29.5%) eyes underwent PK (group 1), 28 (45.9%) eyes received DALK using a fresh corneal graft (group 2), and 15 (24.6%) eyes had DALK using a cryopreserved graft (group 3). Mean follow-up period was 20.2±4.7 months in group 1, 19.4±3.5 months in group 2, and 20.3±5.0 months in group 3 (P=0.65). Final mean BCVA was 0.14±0.08 logMAR, 0.17±0.11 logMAR, and 0.20±0.09 logMAR, respectively (P=0.22). Final spherical equivalent refraction was -1.49±2.05 D, -3.56±4.38 D, and -2.53±3.02 D, respectively (P=0.16). All study groups were comparable in terms of postoperative complications. The rate of non-endothelial graft rejections was significantly lower in group 3 than in groups 1 and 2 (P=0.03).

Cryopreserved corneal tissues can successfully substitute for fresh grafts in DALK.