The use of the femtosecond laser in penetrating keratoplasty

PURPOSE: To evaluate a new technique for penetrating keratoplasty (PK) with the use of a new software algorithm for a femtosecond laser that is designed to create penetrating cuts for PK in the treatment of a number of corneal diseases. DESIGN: Prospective, interventional case series. METHODS: All eyes were treated at the Ospedale Civile di Mestre, Umberto, Italy. Seven eyes of seven patients underwent surgery for PK using a 15-kHz femtosecond laser (IntraLase, Irvine, California, USA) and a new software specifically developed for corneal surgery. Of the seven patients, five were keratoconus patients and two had bullous keratopathy. New software was used to create penetrating cuts in a top hat or mushroom configuration. After surgery, all patients were evaluated with pachymetry, corneal topography, refraction, intraocular pressure measurement, and corneal optical coherence tomography (Visante; Carl Zeiss, Oberkochen, Germany). RESULTS: On postoperative day one, all seven eyes had nearly clear corneas with a good graft of the donor corneas to the patients' corneas. At three months, all eyes had clear corneas with good endothelial cell counts and quiet anterior chambers. Normal corneal thickness was achieved in each case. At the three,month visit, suture removal was performed in five eyes to adjust for astigmatism. CONCLUSIONS: Although this is a small number of eyes early indications are that the use of the new IntraLase software for corneal surgery creates a more favorable environment for PK as a result of a better fit of the donor cornea and a quicker visual recovery for patients.