Comparison of femtosecond laser-assisted deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus.
BACKGROUND
To compare outcomes of femtosecond laser-assisted deep anterior lamellar keratoplasty (FSL-DALK) and penetrating keratoplasty (FSL-PK) for the treatment of keratoconus.


METHODS
Twenty eight eyes underwent FSL-DALK (consisted of 12 eyes in the FSL-DALKa subgroup without baring the Descemet's membrane and 16 eyes in the FSL-DALKb subgroup baring the Descemet's membrane using big-bubble technique) were compared with 12 eyes that underwent FSL-PK for keratoconus. These patients underwent an ophthalmic examination preoperatively and 3, 6, 9, and 12 months postoperatively.


RESULTS
The postoperative BCVA in the FSL-PK group, and the FSL-DALKb subgroup were significantly better than that in the FSL-DALKa subgroup (P < 0.05), whereas no differences were found between the FSL-DALKb subgroup and the FSL-PK group (P > 0.05). There were no significant differences in the mean spherical equivalent (SE) and astigmatism between the FSL-DALK and the FSL-PK groups, nor between the subgroups of FSL-DALK during the follow-up period (P > 0.05). At the last follow-up, the mean endothelial cell loss in the FSL-DALK group (9.12 %) was significantly less than that in the FSL-PK group (20.79 %) (P < 0.001), while there was no difference between the FSL-DALKa (9.15 %) and the FSL-DALKb (9.10 %) subgroups (P = 0.15). The FSL-DALK group seemed to have fewer graft rejections (1/28 cases) than the FSL-PK group (2/12 cases), although Kaplan-Meier curve showed no significant difference between the two groups (P = 0.144).


CONCLUSIONS
In this retrospective study, the results suggested that FSL-DALKb gives better visual outcome, and FSL-DALKb is a better option for keratoconus whose endothelium is not compromised. However, larger and prospective studies are further required.
Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, China. luna198703@hotmail.com.|Tissue Culture Center, Departments of Pathology and Ophthalmology, The New York Eye and Ear Infirmary, New York Medical College, New York, NY, 10003, USA. luna198703@hotmail.com.
Yueqin
Y
Chen
Tissue Culture Center, Departments of Pathology and Ophthalmology, The New York Eye and Ear Infirmary, New York Medical College, New York, NY, 10003, USA. hu2095@yahoo.com.
Dan-Ning
DN
Hu
Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, China. xiayuanjlyy@163.com.
Yuan
Y
Xia
Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, China. ylpjlyy@163.com.
Liping
L
Yang
Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, China. xuechunyancn@163.com.
Chunyan
C
Xue
Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, China. hzpjlyy@hotmail.com.
Zhenping
Z
Huang
D000328:Adult; D000869:Anterior Eye Segment / Q000473:pathology; D001251:Astigmatism / Q000503:physiopathology; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000473:pathology; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D053685:Laser Therapy; D008297:Male; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult