title: Long-term results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To evaluate the long-term results of femtosecond laser-assisted anterior lamellar keratoplasty (FALK) for anterior corneal pathologies.
  
  
  METHODS
  Retrospective, noncomparative, interventional case series.
  
  
  METHODS
  Thirteen consecutive patients who underwent FALK for anterior corneal pathologies.
  
  
  METHODS
  Femtosecond laser-assisted sutureless anterior lamellar keratoplasty.
  
  
  METHODS
  Best spectacle-corrected visual acuity (BSCVA), manifest refraction, need for adjunctive surgery, and complications.
  
  
  RESULTS
  Follow-up ranged from 12 to 69 months (mean = 31 months). The BSCVA was significantly improved over preoperative values at the 12-, 18-, 24-, and 36-month visits. A BSCVA greater than 20/30 was achieved in 54% of patients at the 12-month visit when all 13 patients were available for follow-up, in 50% and 33% of patients at the 18- and 24-month visits, respectively, when 12 patients were available, and in 60% and 50% of patients at the 36- and 48-month visits when 5 and 2 patients were available, respectively. The BSCVA of the eye that completed the 60- and 70-month visits was 20/50. Patients achieved a mean gain of 5 lines of BSCVA at the 6-, 12-, 18-, and 24-month visits, 4 lines at the 36-month visit, 5 lines at the 48-month visit, and 6 lines at the 60- and 72-month visits. Two patients lost a mean of 1.5 lines of BSCVA because surface haze developed after photorefractive keratectomy (PRK) and granular dystrophy recurred in the graft. At a mean of 5 weeks postoperatively, 83.3% of patients achieved BSCVA within 2 lines of that recorded at the 24-month visit. At the 12-month visit, mean spherical equivalent and refractive astigmatism were -0.4 diopters (D) and 2.2 D, respectively, with no significant shift from preoperative values or values recorded in different follow-up visits. Adjunctive surgeries included phototherapeutic keratectomy, PRK, cataract extraction, and epithelial ingrowth debridement. Complications included residual corneal pathology, mild interface haze, anisometropia, recurrence of pathology, haze after adjunctive PRK, dry eye, epithelial ingrowth, and suspicious ectasia.
  
  
  CONCLUSIONS
  Femtosecond laser-assisted sutureless anterior lamellar keratoplasty improves the BSCVA of patients with anterior corneal pathologies with rapid visual rehabilitation and no significant induced astigmatism. Our preliminary results indicate that FALK results remained stable throughout the follow-up period.
authors.affiliation: Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Florida, USA.
authors.forename: Mohamed Abou
authors.initials: MA
authors.lastname: Shousha
authors.forename: Sonia H
authors.initials: SH
authors.lastname: Yoo
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ide
authors.forename: William
authors.initials: W
authors.lastname: Feuer
authors.forename: Carol L
authors.initials: CL
authors.lastname: Karp
authors.forename: Terrence P
authors.initials: TP
authors.lastname: O'Brien
authors.forename: William W
authors.initials: WW
authors.lastname: Culbertson
authors.forename: Eduardo
authors.initials: E
authors.lastname: Alfonso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002387:Cataract Extraction; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D011379:Prognosis; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D013536:Suture Techniques; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult