Abstract
Purpose: :
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.
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Keywords: cornea: clinical science • laser • transplantation