To evaluate the long-term stability of subjective refraction after deep anterior lamellar keratoplasty (DALK) performed in keratoconus-affected eyes.

This retrospective, comparative interventional case series analyzed the data of 73 eyes in 69 patients with keratoconus who underwent DALK. Only patients with clear grafts who had all sutures removed for at least 12 months were enrolled. The corrected distance visual acuity (CDVA) and manifest refraction were measured several months after all sutures were removed. The CDVA, spherical equivalent refraction, refractive astigmatism, and vector components of refractive astigmatism (J0 and J45) were recorded and compared at different time points.

Mean age of patients was 28.3 6 8.3 years at the time of keratoplasty. No significant changes in the CDVA were observed during the follow-up period. Spherical equivalent refraction measured at 1 month (23.18 6 3.41 D) and 3 months (24.29 6 4.26 D) after complete suture removal differed significantly from that measured at the last examination (24.70 6 3.75 D; P = 0.001 and 0.03, respectively). This measurement stabilized from 6 months after complete suture removal onward. Refractive astigmatism and its vector components (J0 and J45) did not change over time after complete suture removal

: Refraction stabilized 6 months after complete DALK suture removal. Therefore, postponing refractive surgery until this time is advisable to manage post-DALK refractive errors.