title: Long-term outcomes of femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To review the long-term outcomes after femtosecond laser (FSL)-assisted mushroom configuration deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  Noncomparative case series of 19 eyes from 19 patients who underwent FSL-assisted mushroom configuration DALK.
  
  
  RESULTS
  Data were available for 14 eyes at 1 month, for 14 at 3 months, for 16 at 6 months, for 10 at 9 months, and for 8 at 1 year. Preoperative mean best-corrected visual acuity was 20/108 (range: 20/30-20/400). At 3 months, the mean best-corrected visual acuity was 20/46 (range: 20/25-20/250), and at a mean final follow-up of 13 months (range: 6-29) it was 20/35 (range: 20/15-20/200). The greatest change in mean spherical equivalent was at 3 months [-2.29 diopters (D), range: -7.38 to +3.38 D; from -9.54 D, range: -20.00 to +3.38 D, preoperatively]. There was 56% reduction in mean keratometric cylinder at 6 months (4.00 D, range: 1.04-8.75 D; from 9.13 D, range: 0.50-18.75 D, preoperatively). Complications included 3 cases (15.8%) of small Descemet membrane perforation, none of which required conversion to penetrating keratoplasty; 3 cases (15.8%) of stromal rejection that resolved with topical steroids; and 6 cases (31.6%) of steroid-related intraocular pressure rise that were treated with topical medications. Selective suture removal was initiated a mean of 3.5 months (range: 1.5-6 months) after surgery.
  
  
  CONCLUSIONS
  The use of the FSL to perform corneal cuts in a mushroom configuration for DALK is reliable and reproducible. Earlier visual rehabilitation may be possible because of the mechanical stability and wound healing advantages of stepped corneal wounds.
authors.affiliation: Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. raneen_sh_mash@hotmail.com
authors.forename: Raneen
authors.initials: R
authors.lastname: Shehadeh-Mashor
authors.forename: Clara
authors.initials: C
authors.lastname: Chan
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Yeung
authors.forename: Alex
authors.initials: A
authors.lastname: Lichtinger
authors.forename: Maoz
authors.initials: M
authors.lastname: Amiran
authors.forename: David S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: D000293:Adolescent; D000328:Adult; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery; D048988:Corneal Surgery, Laser / Q000379:methods*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult