title: Femtosecond laser-assisted repeat keratoplasty: a case series.
abstract: OBJECTIVE
  To evaluate the feasibility of femtosecond laser-assisted repeat penetrating keratoplasty (PK) in eyes having undergone corneal graft, thus presenting intracorneal scar tissue.
  
  
  METHODS
  Repeat PK was performed with femtosecond laser (Intralase FS TM System; Abbott Medical Optics, Inc, Santa Ana, CA) creating a "top-hat" or "mushroom" configuration.
  
  
  RESULTS
  Four patients were included in this study. Indications for repeat PK included recurrent keratoconus (n = 2), endothelial graft failure (n = 1) after conventional PK, and low visual acuity after lamellar keratoplasty (n = 1). Eyes were trephinated within or including the first graft. Complete uneventful femtosecond laser-assisted trephination occurred in 3 of 4 patients. In 1 patient, laser trephination had to be completed manually because of tissue bridges. Histological examination of the host corneas revealed straight cutting edges according to the programmed shape. Visual outcome in all patients was reduced because of uncontrolled intraocular pressure, postoperative trauma, and irregular astigmatism.
  
  
  CONCLUSIONS
  This small case series demonstrates that repeat PK with femtosecond laser is technically a suitable method when the peripheral cornea is sufficiently clear.
authors.affiliation: University Eye Hospital Freiburg, Freiburg, Germany. sybille.graef@uniklinik-freiburg.de
authors.forename: Sybille
authors.initials: S
authors.lastname: Graef
authors.forename: Philip
authors.initials: P
authors.lastname: Maier
authors.forename: Daniel
authors.initials: D
authors.lastname: Boehringer
authors.forename: Claudia
authors.initials: C
authors.lastname: Auw-Haedrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000517:prevention & control; D003316:Corneal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology