CORNEAL AND EXTERNAL DISORDERS: Edited by Shahzad I. MianOptimizing outcomes for keratoplasty in ectatic corneal diseaseYu, Angeli Christya,b,c; Mattioli, Leilab,c; Busin, Massimoa,b,cAuthor Information aDepartment of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara bDepartment of Ophthalmology, Ospedali Privati Forlì ‘Villa Igea’ cIstituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy Correspondence to Massimo Busin, MD, Department of Ophthalmology, Ospedali Privati Forlì ‘Villa Igea’, 47122 Forlì, Italy. Tel: +39 347 2449343; fax: +39 543 419566; e-mail: firstname.lastname@example.org Current Opinion in Ophthalmology: July 2020 - Volume 31 - Issue 4 - p 268-275 doi: 10.1097/ICU.0000000000000666 Buy Metrics Abstract Purpose of review Advanced keratectasia often requires corneal transplantation for restoration of vision. This review discusses the surgical approach suitable for these cases including significant updates in the current literature. Recent findings With greater understanding of ectatic corneal disease and its associated operative challenges, several modifications in the surgical approach have been developed. Identified predictive factors for successful pneumatic dissection and intraoperative complications have informed surgical planning and decision-making. In the setting of failed pneumatic dissection, sequential use of alternative lamellar dissection techniques is a reasonable surgical strategy. Surgical refinements to optimize visual outcomes and postoperative interventions to correct residual refractive errors have improved visual rehabilitation after keratoplasty. Summary With evidence of its undisputed advantages, DALK has been widely recognized as the primary surgical option for ectatic corneal disease. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.