Blood-aqueous barrier after mechanical or nonmechanical excimer laser trephination in penetrating keratoplasty

PURPOSE: To analyze whether nonmechanical trephination with an excimer laser influences postoperative blood aqueous barrier breakdown after penetrating keratoplasty, METHODS: Patients undergoing penetrating keratoplasty for keratoconus or Fuchs dystrophy were prospectively randomly assigned to trephination by either excimer laser or conventional mechanical handheld motorized trephine, All surgery was performed by one surgeon, and preoperative, intraoperative, and postoperative treatment was identical in both groups. Aqueous Bare was quantitatively determined postoperatively in a masked fashion by laser Bare-cell meter, For statistical analysis, the nonparametric Wilcoxon Mann-Whitney test: was used, RESULTS: A total of 52 eyes of 52 patients were examined (Fuchs dystrophy, 10; keratoconus, 4-2), During the early postoperative period (days 3 to 9), eyes that had undergone nonmechanical excimer laser trephination (25/52) showed significantly (P <.005) lower flare values than did eyes that had undergone mechanical trephination (27/ 52). In both groups, Bare values returned to normal levels by 6 weeks postoperatively, CONCLUSION: Early postoperative blood-aqueous barrier breakdown is less pronounced after penetrating keratoplasty with nonmechanical excimer laser trephination.