title: Outcome of "mushroom" pattern femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty in patients with keratoconus.
abstract: OBJECTIVE
  The aim of this study was to compare the outcomes of "mushroom" femtosecond laser-enabled keratoplasty (M-FLEK) with those of conventional penetrating keratoplasty (PKP) in eyes with keratoconus. The femtosecond laser-enabled "mushroom" pattern keratoplasty technique results in less postoperative astigmatism and higher endothelial cell counts compared with conventional PKP in patients with keratoconus.
  
  
  METHODS
  This was a nonrandomized retrospective, single private center clinical study. Between March 2010 and April 2012, 26 eyes underwent M-FLEK and 33 eyes underwent conventional PKP. Data on preoperative and postoperative manifest refraction, uncorrected visual acuity and best-corrected visual acuity (BCVA), endothelial cell counts, vector analysis, and complications were retrieved and analyzed.
  
  
  RESULTS
  At 12 months of follow-up, the mean logMAR BCVA was 0.31 ± 0.55 in the M-FLEK group and 0.32 ± 0.21 in the PKP group (P = 0.91). The mean spherical equivalent was similar between the groups. The mean manifest cylinder was significantly lower in the M-FLEK group (-2.84 ± 1.08 diopters) than in the PKP group (-3.93 ± 2.26 diopters; P = 0.03). There was a smaller mean endothelial cell loss in the M-FLEK group compared with the PKP group (32.1% vs 38.7%, respectively, P = 0.17) 1 year postoperatively. The complication rates were similar for both groups.
  
  
  CONCLUSIONS
  M-FLEK appears to be a safe procedure that results in less astigmatism and a trend toward higher endothelial cell counts compared with conventional PKP, with similar postoperative BCVA.
authors.affiliation: *Department of Ophthalmology, Tel Aviv Sourasky Medical Center (affiliated to the Sackler Faculty of Medicine), Tel-Aviv University, Tel-Aviv, Israel; and †Enaim Medical Center, Jerusalem, Israel.
authors.forename: Eliya
authors.initials: E
authors.lastname: Levinger
authors.forename: Omer
authors.initials: O
authors.lastname: Trivizki
authors.forename: Shmuel
authors.initials: S
authors.lastname: Levinger
authors.forename: Israel
authors.initials: I
authors.lastname: Kremer
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000517:prevention & control; D002452:Cell Count; D063171:Corneal Pachymetry; D048988:Corneal Surgery, Laser / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult