To evaluate the long-term clinical results of deep anterior lamellar keratoplasty (DALK, Melles technique) in keratoconus patients with two different rim patterns

Main outcome measure were patients’ demographics, preoperative and postoperative best spectacle–corrected visual acuities (BSCVAs), Corneal and refraction astigmatism were measured at 3, 6, 12 months. Wavefront analysis was analysis with I-Trace; Intraocular pressure, and Corneal biomechanical study were measured with ORA and Corvis at 6 months postoperatively

The mean age of the patients was 25.35 years, for Decagonal and 26.65 years for mushroom. There was no complication. Mean post-operative BSCVA was 0.15 logmar in decagonal and 0.14 in mushroom at 12 months. Mean corneal astigmatism was 2.8 D in decagonal and 2.5 D in mushroom. Mean spherical equivalent was -3.00 D in decagonal and -2.00 D in mushroom. Mean keratometry was 25.2 D in decagonal and 46.7 D in mushroom. Mean root mean square, spherical aberration and coma were 4.29, 0.048 and 0.35 in decagonal and 4.14, 0.02 and 0.35, in mushroom, respectively. Mean corneal hysteresis and corneal resistant factor were 8.44 and 9.00 in decagonal and 9.00 and 9.18, in mushroom, respectively. Mean IOPcc were 17 in decagonal and 17 in mushroom with ORA and 17.4 in decagonal and 16.3 in mushroom with corvis. Deformation amplitude, applanation length 1, applanation length 2, applanation time 1 and applanation time 2 were 1.11, 1.84, 1.12, 7.40, and 19.89 in decagonal and 1.14, 1.90, 1.53, 7.23 and 19.91 in mushroom, respectively.

There was no clinical significant difference between decagonal or mushroom Femto-enable DALK in issues of corneal indices, refractive and biomechical status. Both rim patterns were safe and acceptable.