Anatomical and functional results of femtosecond laser-assisted descemet stripping automated endothelial keratoplasty compared to microkeratome-assisted descemet stripping automated endothelial keratoplasty

Abstract

Introduction: Femtosecond laser devices have been praised for their precision in corneal surgery; however, their performance in endothelial corneal graft surgery is still in development compared to the standard microkeratome technique. The purpose of this study is to describe the anatomical and functional differences in surgical outcomes between microkeratome (mk) and femtosecond laser (fs) assisted Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This is an analytic, observational, pilot study of patients who underwent mk-DSAEK or fs-DSAEK. The data were obtained from the clinical records and the institutional transplant registry with a focus on graft measurements, survival, transparency, visual acuity and was further analyzed. Results: A total of 37 participants were included in the study with 70.3% (n = 26) of them being female and 29.7% of them being male (n = 11). Of the 37 eyes, 23 (62.2%) of them underwent mk-DSAEK and 14 (37.8%) of them underwent fs-DSAEK. Optimized femtosecond laser parameters are reported. There was a statistically significant difference in donor graft thickness which was thinner in the fs-DSAEK group with a median of 110 mm interquartile range (IQR) (102.25–117.5) versus a median of 233 mm IQR (219–243.75) P = 0.00 in the mk-DSAEK group. There were no significant differences for other variables between techniques. Conclusion: Fs-DSAEK allowed significantly thinner graft obtention in comparison to mk-DSAEK; however, there were no significant differences between mk-DSAEK and fs-DSAEK in terms of transparency, graft survival, or visual acuity.