title: Laser-assisted penetrating keratoplasty: 1-year results in patients using a laser-welded anvil-profiled graft.
abstract: OBJECTIVE
  To describe a new laser-assisted penetrating keratoplasty technique combining a femtosecond anvil-like trephination pattern with the laser welding procedure.
  
  
  METHODS
  Cohort prospective study with 1 year of follow-up (June 2011 through January 2013).
  
  
  METHODS
  This study was performed at Misericordia e Dolce Public Hospital, Prato, Italy. Twenty-four eyes of 22 patients underwent penetrating keratoplasty: 4 had granular dystrophy, 12 had keratoconus in its final stages, 3 had post-herpetic leukoma, and 5 had corneal scars. A femtosecond laser was used to create anvil-profiled cuts in donor and recipient corneas. Diode laser welding was performed, supporting standard suturing. All patients were evaluated for corrected distance visual acuity, pachymetry, manifest astigmatism, and endothelial cell density after 1, 3, 6, and 12 months.
  
  
  RESULTS
  Mean ± standard deviation postoperative corrected visual acuity was 0.48 ± 0.23 logarithm of the minimal angle of resolution (logMAR), 0.30 ± 0.18 logMAR, 0.18 ± 0.13 logMAR, and 0.13 ± 0.16 logMAR at 1, 3, 6, and 12 months, respectively. At the same follow-up times, mean pachymetry was 537 ± 57 μm, 533 ± 74 μm, 528 ± 72 μm, and 529 ± 58 μm, respectively; and mean endothelial cell density was 1945 ± 371 cells/mm(2), 1881 ± 410 cells/mm(2), 1781 ± 401 cells/mm(2), and 1730 ± 376 cells/mm(2), respectively. Mean manifest and topographic postoperative astigmatism were: 3.6 ± 2.5 diopters (D) and 4.65 ± 2.57 D at 1 month, 2.93 ± 2.34 D and 4.79 ± 2.85 D at 3 months, 2.82 ± 1.75 D and 3.44 ± 2.28 D at 6 months, and 2.08 ± 1.25 D and 2.73 ± 2.01 D at 12 months, respectively. All surgical operations were successful and without intraoperative complications.
  
  
  CONCLUSIONS
  The use of the anvil trephination profile was effective for performing laser-assisted penetrating keratoplasty. The large donor-recipient interface enables the laser welding procedure and good preservation of the recipient's endothelial cell pool.
authors.affiliation: Unità Operativa Oculistica Ospedale "Misericordia e Dolce", Prato, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Canovetti
authors.affiliation: Unità Operativa Oculistica Ospedale "Misericordia e Dolce", Prato, Italy.
authors.forename: Alex
authors.initials: A
authors.lastname: Malandrini
authors.affiliation: Unità Operativa Oculistica Ospedale "Misericordia e Dolce", Prato, Italy.
authors.forename: Ivo
authors.initials: I
authors.lastname: Lenzetti
authors.affiliation: Italian National Research Council, "Nello Carrara" Institute of Applied Physics, Florence, Italy. Electronic address: f.rossi@ifac.cnr.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Italian National Research Council, "Nello Carrara" Institute of Applied Physics, Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pini
authors.affiliation: Unità Operativa Oculistica Ospedale "Misericordia e Dolce", Prato, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Menabuoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000503:physiopathology; D002452:Cell Count; D003315:Cornea / Q000503:physiopathology; D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery*; D063171:Corneal Pachymetry; D048988:Corneal Surgery, Laser / Q000379:methods*; D019781:Corneal Topography; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult