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Simon S. Fung, Francesco Aiello, Alfonso Iovieno, Carlo Nucci, Vincenzo Maurino; Femtosecond Laser-Assisted Mushroom Configuration Penetrating Keratoplasty And Deep Anterior Lamellar Keratoplasty In Advanced Keratoconus. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6058.
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To evaluate the outcomes after femtosecond laser-assisted mushroom configuration penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in advanced keratoconus.
Eleven eyes of eleven patients (7 male; 4 female) with a mean age of 31 ± 9.9 years (range 21-51) underwent femtosecond laser-assisted mushroom configuration PK and DALK. Preoperative risk factors include previous hydrops (n=4) and previous laser-assisted in situ keratomileusis (n=1). Recipient and donor corneas were treated with 150-KHz Femtosecond laser (Intralase FS TM System; Abbott Medical Optics, Inc, Santa Ana, CA) to create mushroom-shaped recipient bed and donor. The donor posterior side cut depth was always set at 80 µm from endothelium to avoid donor femtosecond laser penetration during the laser procedure.
Mean follow up was 10.7 months (range 4-19 months). Preoperative mean best corrected visual acuity (BCVA) was 1.26 ± 0.51 LogMAR and mean central cornea thickness was 278 ± 109 µm. Mean keratometric (K) value and mean maximum K value were 63.1 ± 7.84 D and 76.0 ± 9.3 D respectively. In total, 4 patients underwent PK and 7 patients underwent DALK, with 2 of the latter converted to PK due to Descemet membrane perforations. At the last follow-up, mean BCVA was 0.69 ± 0.34 LogMAR, mean spherical equivalent refractive error was -3.4 ± 2.92 D, and mean cylindrical refractive error was 5.1 ± 3.2 D. Postoperative mean K value was 43.3 ± 1.5D and the mean maximum K value was 49.0 ± 2.4 Selective suture removals were performed in six patients at a mean of 8.5 ± 6 months postoperatively.
This preliminary series demonstrate that femtosecond laser-assisted mushroom-configuration keratoplasty is a feasible and safe procedure in patients with advanced keratoconus. Despite the pre-existing high risk characteristics, this technique provides good wound approximation and wound healing while producing comparable results to those with less severe disease.
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