Results of penetrating keratoplasty performed with a femtosecond laser zigzag incision initial report

Purpose: To determine the initial outcomes of utilizing a femtosecond laser to perform penetrating keratoplasty incisions in a zigzag pattern. Design: Retrospective consecutive surgical series. Participants: Patients undergoing full-thickness corneal transplant surgery in a referral academic practice. Methods: The IntraLase femtosecond laser performed matching donor and host zigzag incisions in a consistent pattern in 13 eyes of 13 patients. Main Outcome Measures: Topographically determined astigmatism, imaging of incisions by anterior segment optical coherence tomography, and best spectacle-corrected visual acuity (BSCVA). Results: Postoperative follow-up ranged from 3 to 9 months. Mean astigmatism was <= 3.0 diopters (D) at all intervals beginning at 1 month postoperatively. Maximum astigmatism was 4.25 D from month 3 onward. Nine eyes (69%) had <= 3 D and 6 eyes (46%) had <= 2 D by month 3. In the 8 eyes with full vision potential, 7 (87.5%) had BSCVA >= 20/30 by month 3; the eighth eye had improved to 20/25 by month 6. Optical coherence tomography images showed excellent anterior and posterior wound alignment, including one eye where the running suture loosened and was fully removed before month 3. Conclusions: The femtosecond laser-generated zigzag incision is biomechanically stable, resulting in excellent wound apposition, wound integrity with minimal suture tension, and recovery of good levels of BSCVA with moderate astigmatism within months of surgery.