title: Femtosecond laser-assisted inverted mushroom keratoplasty.
abstract: OBJECTIVE
  To evaluate best-corrected visual acuity (BCVA), refractive outcome, corneal topography, optical coherence tomography, and endothelial cell density 12 months after femtosecond laser-assisted inverted mushroom keratoplasty.
  
  
  METHODS
  We performed a prospective study of a surgical case series of 5 patients undergoing femtosecond laser-assisted inverted mushroom keratoplasty for pseudophakic bullous keratopathy or pre-Descemet X-linked ichthyosis. The femtosecond laser was used to create a top-hat configuration in the donor cornea and recipient cornea. Laser parameters were as follows: energy, 4.0 (anterior inner vertical side cut and horizontal lamellar cut) and 7.0 microJ (posterior outer vertical side cut); spiral pattern with a firing rate of 15 kHz. The size of the anterior inner diameter was 7.4 mm in the donor cornea and 7.0 mm in the recipient cornea. The posterior outer diameter was 9.0 mm in all eyes.
  
  
  RESULTS
  At 6 and 12 months after surgery, all corneal grafts were clear and showed an excellent adaptation of the lamellar donor and recipient wound surfaces. At 12 months postoperatively, BCVA averaged 20/32 (range, 20/60-20/20), refractive cylinder averaged -3.20 +/- 2.0 D, topographical cylinder averaged 3.26 +/- 2.1 D, and the mean endothelial cell density was 1793 +/- 491 cells/mm2 (range, 954-2237 cells/mm2). The mean central corneal thickness and thickness of the posterior shelf was 517 +/- 3 and 175 +/- 8 microm, respectively.
  
  
  CONCLUSIONS
  The femtosecond laser-assisted inverted mushroom keratoplasty shows good promise in surgical treatment of corneal diseases. The multiplanar fit between the donor and recipient cornea allows early suture removal and visual rehabilitation.
authors.affiliation: Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: Yanny Y Y
authors.initials: YY
authors.lastname: Cheng
authors.forename: Nayyirih G
authors.initials: NG
authors.lastname: Tahzib
authors.forename: Gabriel
authors.initials: G
authors.lastname: van Rij
authors.forename: Hugo
authors.initials: H
authors.lastname: van Cleynenbreugel
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pels
authors.forename: Fred
authors.initials: F
authors.lastname: Hendrikse
authors.forename: Rudy
authors.initials: R
authors.lastname: Nuijts
mesh_terms: D000328:Adult; D000368:Aged; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D016114:Ichthyosis, X-Linked / Q000601:surgery*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D013536:Suture Techniques; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing