{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:21:16Z","timestamp":1792027276649,"version":"4.4.0"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T00:00:00Z","timestamp":1622246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We compared the visual and refractive outcomes, intraocular pressure (IOP), endothelial cell loss (ECL), and adverse events in keratoconus patients after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) with the best corrected visual acuity (BCVA) below 0.3 (logMAR 0.52). This is a prospective, comparative cohort study of 90 eyes (90 patients) with a clinical diagnosis of keratoconus. Patients underwent a complete eye examination before the surgical approach, 6 and 12 months postoperatively that consisted of BCVA, refractive astigmatism (AS), central corneal thickness (CCT), IOP, and ECL. Secondary outcomes were adverse events related to the surgical procedure. With lower ECL and less adverse events, DALK was revealed to be beneficial over PK with similar visual outcomes. Results: There was no significant difference between the BCVA in the DALK and PK groups (at 6 months: 0.49 \u00b1 0.17 vs. 0.48 \u00b1 0.17; p = 0.48; at 12 months: 0.54 \u00b1 0.17 vs. 0.52 \u00b1 0.14; p = 0.41). The mean value of AS was significantly lower after the PK procedure when compared to DALK, after both 6 and 12 months of follow up (p &lt; 0.001). The CCT in the DALK group was significantly lower when compared to the PK group (at 6 months: 452.1 \u00b1 89.1 \u00b5m vs. 528.9 \u00b1 69.9 \u00b5m, p &lt; 0.0001; at 12 months: 451.6 \u00b1 83.5 \u00b5m vs. 525.5 \u00b1 37.1 \u00b5m). The endothelial cell loss at 12 months after surgery was significantly lower after DALK when compared to PK (p &lt; 0.0001). DALK transplantation should be considered as an alternative procedure in the surgical treatment of keratoconus.<\/jats:p>","DOI":"10.3390\/jcm10112421","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T01:51:37Z","timestamp":1622425897000},"page":"2421","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Comparison of Long-Term Outcomes of the Lamellar and Penetrating Keratoplasty Approaches in Patients with Keratoconus"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9983-5272","authenticated-orcid":false,"given":"Dominika","family":"Janiszewska-Bil","sequence":"first","affiliation":[{"name":"Optegra Eye Clinic, 40-101 Katowice, Poland"},{"name":"Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Czarnota-Nowakowska","sequence":"additional","affiliation":[{"name":"Optegra Eye Clinic, 61-101 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Krysik","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland"},{"name":"Department of Ophthalmology, Faculty of Medicine in Zabrze, University of Technology, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4405-8020","authenticated-orcid":false,"given":"Anita","family":"Lyssek-Boro\u0144","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland"},{"name":"Department of Ophthalmology, Faculty of Medicine in Zabrze, University of Technology, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8768-1691","authenticated-orcid":false,"given":"Dariusz","family":"Dobrowolski","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland"},{"name":"Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1633-7145","authenticated-orcid":false,"given":"Beniamin Oskar","family":"Grabarek","sequence":"additional","affiliation":[{"name":"Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology in Katowice, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Wyl\u0119ga\u0142a","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/ICO.0000000000002150","article-title":"The prevalence and risk factors for keratoconus: A systematic review and meta-analysis","volume":"39","author":"Hashemi","year":"2020","journal-title":"Cornea"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3389\/fbioe.2019.00066","article-title":"A review of structural and biomechanical changes in the cornea in aging, disease, and photochemical crosslinking","volume":"7","author":"Blackburn","year":"2019","journal-title":"Front. 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