Clinical results of 123 femtosecond laser-assisted penetrating keratoplasties

Postoperative astigmatism following penetrating keratoplasty is a major problem after corneal transplantation. The main goal of new trephination techniques such as femtosecond laser or excimer-laser trephination is to improve refractive and visual outcomes. The femtosecond laser technique makes profiled corneal trephinations such as the top hat or mushroom profile possible. We present the postoperative outcome of femtosecond laser-assisted penetrating keratoplasties. We performed 123 femtosecond laser-assisted penetrating keratoplasties in 119 patients. The main outcome measures were intraoperative specifics, astigmatism, and irregularity in Orbscan corneal topography, as well as the occurrence of immune reactions and side-effects. All sutures have been removed in 49 of these 123 eyes. Their mean follow-up was 13.9 +/- 4.5 months. Time to complete suture removal (n = 49) was 12.0 +/- 3.7 months in the mushroom group and 9.8 +/- 2.1 months in the top hat group. Mean astigmatism in Orbscan topography was 6.4 +/- 3.0 diopters in the mushroom and 5.8 +/- 4.6 diopters in the top hat group (all sutures out). Femtosecond laser-assisted penetrating keratoplasty is a safe surgical technique. Due to the steps in profiled trephinations, the wound area is larger and theoretically the wound healing is, thus, faster and more stable. Complete suture removal is possible at an earlier time point compared to conventional penetrating keratoplasty. However, refractive results are not superior to those following conventional trephination.