Femtosecond-assisted deep anterior lamellar keratoplasty using big-bubble technique in a cornea with 16 radial keratotomy incisions.
OBJECTIVE
To report on a patient with uncorrectable fluctuating astigmatism from multiple previous radial keratotomy (RK) procedures who successfully underwent a femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK) with big-bubble technique.


METHODS
A 60-year-old woman with a history of multiple RK procedures with 16 radial incisions and 4 Ruiz-style cuts had fluctuating corneal astigmatism with preoperative best contact lens-corrected visual acuity of 20/80.


RESULTS
Intraoperatively, a femtosecond laser-assisted zigzag pattern DALK was performed. Descemet baring was successfully achieved using the big-bubble technique without air escaping from the radial incisions, likely related to precise depth of base of posterior side cut made by laser. Postoperative best-corrected visual acuity is 20/25 with 1.3 diopter of astigmatism at 5 months.


CONCLUSIONS
To our knowledge, this is the first report to use this technique in a cornea with RK incisions. Femtosecond lasers may promote the success of DALK in challenging corneas.
chamber@ohsu.eduCasey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.
Winston
W
Chamberlain
Mauricio
M
Cabezas
D000388:Air; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003315:Cornea / Q000473:pathology; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005139:Eyeglasses; D005260:Female; D006801:Humans; D007646:Keratotomy, Radial / Q000009:adverse effects*; D053685:Laser Therapy; D008863:Microspheres; D008875:Middle Aged; D012086:Reoperation; D014792:Visual Acuity