We are very grateful for the opportunity to address all the concerns about our article. Our responses to the readers’ comments follow.

We checked axial length and vitreous cavity length of all patients with A-scan, and we checked posterior sclera of all patients with B-scan. The patients with a feature of posterior scleral staphyloma or obviously increased eye length were excluded.

There are, respectively, 5 and 7 eyes excluded from the same-size group and oversize group because of failure of big bubble formation, instead of 7 and 5 eyes. Therefore, we have 54 eyes in the same-size group and 52 eyes in the oversize group. During the follow-up, we lost some patients every year, and that is why we have 45 eyes in the same-size group and 47 eyes in the oversize group at the fifth year.

Treating keratoconus with deep anterior lamellar keratoplasty (DALK) does cause Descemet folds. However, we find the incidence and level of Descemet folds mainly related to the preoperative K value of topographic power. If K value > 60 diopters (D), especially K > 65 D, the incidence and level of Descemet folds will highly increase. Also, the incidence and level of Descemet folds had no significant difference between same-size and oversize groups. Moreover, Descemet folds will disappear after 12-18 months postoperatively.

The eyes with hyperopic spherical equivalent are not excluded when we compared the spherical equivalent results. We integrated statistical results as Figure 3, and the P values and ratios of eyes with hyperopic spherical equivalent in 2 groups are shown.

After 3 years of follow-up, eye axial length seemed to be longer in both groups, but significant differences only occurred at 5 years of follow-up.

We are really sorry for our negligence, and we have corrected the spelling of axial length in Figure 6 (“axital” should be “axial”).

In the case of elevation of intraocular pressure (IOP), for 1 week after administration of topical antiglaucoma medications, along with stopping use of steroids, the IOP decreased to the normal level. During the follow-up, the IOP did not increase again. And we did not find any rejection caused by the elevation of IOP as well as stopping use of steroids. The explanations for these may be that DALK has a low incidence of rejection, and also keratoconus has a lower incidence of rejection.

We are so sorry for our negligence regarding the reference numbers. In the discussion column, the study by Wlison and Bourne should be reference 14.

We thank Sharma and associates for their comments. We are still working on this research, and now the same-size DALK technique for keratoconus patients has become a routine surgery in our clinic practice. We would glad to further discuss and share our experience on this topic.