Abstract
Purpose: :
To evaluate the outcomes after femtosecond laser-assisted mushroom configuration penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in advanced keratoconus.
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Keywords: cornea: clinical science • laser • transplantation