title: Outcomes of femtosecond laser-assisted mushroom-configuration keratoplasty in advanced keratoconus.
abstract: OBJECTIVE
  To evaluate the long-term outcomes after femtosecond laser (FSL)-assisted mushroom-configuration keratoplasty in advanced keratoconus.
  
  
  METHODS
  Thirteen eyes with Amsler-Krumeich stage IV keratoconus underwent FSL-assisted mushroom-configuration penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) at a tertiary referral centre. Preoperative risk factors included low orneal thickness, high keratometry measurements, previous hydrops, and central stromal scarring. Main outcome measures were visual acuity and refractive outcome.
  
  
  RESULTS
  The median follow-up was 33 months (range: 4-43). Preoperatively, the mean corrected distance visual acuity (CDVA) was 1.22±0.47 LogMAR (range: 0.5-1.9 LogMAR), mean minimum corneal thickness was 282±100.8 μm (range: 147-478 μm), and mean average keratometric (K) value was 63.4±7.63 dioptre (D; range: 57.0-75.7 D). Four patients underwent PKP and nine underwent DALK (two converted to PKP). Five patients subsequently underwent a modified arcuate mushroom interface dissection (AMID) procedure for astigmatic correction. At the final follow-up, the mean CDVA was 0.05±0.13 LogMAR (range: -0.10 to 0.20 LogMAR), mean spherical equivalent was -3.21±3.21D, mean cylindrical refractive error was 3.23±2.20 D, and mean average K was 43.1±1.53 D. Complications included early graft dehiscence, corneal vascularisation, stromal rejection, and sclerokeratitis. Sutures were completely removed at the mean 18.4 months for PKP and 9.1 months for DALK postoperatively.
  
  
  CONCLUSIONS
  FSL-assisted mushroom-configuration keratoplasty is feasible and safe in patients with stage IV keratoconus. AMID could further enhance the refractive outcome safely.
authors.affiliation: Cornea and External Disease Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors.forename: S S M
authors.initials: SS
authors.lastname: Fung
authors.affiliation: Cornea and External Disease Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.|Department of Experimental Medicine and Surgery, Ophthalmology Unit, University of Rome 'Tor Vergata', Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Aiello
authors.affiliation: Cornea and External Disease Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Maurino
mesh_terms: D000328:Adult; D048988:Corneal Surgery, Laser / Q000379:methods*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology