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F. Birnbaum, A. Wiggermann, D. Böhringer, P. Maier, T. Reinhard; Femtosecondlaser Assisted Penetrating Keratoplasty - First Clinical Results. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2199.
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Functional results of penetrating keratoplasty are often impaired by postoperative astigmatism. This is due to inadequacy of trephination, suturing, astigmatism of the donor and wound healing. A promising new approach is the femtosecondlaser assisted penetrating keratoplasty. Different laser profiles like the tophat- or the mushroom-profile may be performed using this technique.
We performed 26 mushroom-keratoplasties and 42 tophat-keratoplasties to date. Mean follow-up is 3.3 months. We used the tophat-profile in patients with Fuchs endothelial dystrophy, bullous keratopathy and keratoconus. The mushroom-profile was used exclusively in patients with keratoconus. The side cut differed between 1.0mm and 2.0mm, resulting in an overlap of 0.5mm or 1.0mm, respectively.
The average best corrected visual acuity is 10/20 in the mushroom group and 6/30 in the tophat group. All patients have at least one running suture left.The postoperative astigmatism in Orbscan topography was 6.5±4.4 diopters (mean±standard deviation) in the mushroom group and 5.0±3.0 diopters in the tophat group.
Femtosecondlaser assisted penetrating keratoplasty allows for new trephination profiles with a larger stromal contact surface between graft and recipient. Therefore a higher wound stability can be supposed. This might lead to an earlier suture removal and possibly to a better refractive outcome. Our current results are obtained in an early postoperative stage with predominantly 2 or 1 running sutures in. The benefits from this technique will most likely reveal only after complete suture removal.
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