Long-Term Outcomes of Femtosecond Laser–Assisted Mushroom Configuration Deep Anterior Lamellar Keratoplasty

Abstract

The use of the FSL to perform corneal cuts in a mushroom configuration for DALK is reliable and reproducible. Earlier visual rehabilitation may be possible because of the mechanical stability and wound healing advantages of stepped corneal wounds.

Outcomes of femtosecond laser-assisted mushroom-configuration keratoplasty in advanced keratoconus

“…Despite the high-risk characteristics, visual acuity and refractive outcomes at the final follow-up were comparable to previous studies. 11,12,14 The mean time to complete suture removal was different between PKP and DALK, but is comparable to previous studies of FSL-assisted PKP and DALK. 11,14 Stepped corneal trephination has the advantage of creating a larger surface area at the graft-host interface, leading to improved wound apposition, faster woundhealing, and allowing earlier suture removal.…”

“…11,12,14 The mean time to complete suture removal was different between PKP and DALK, but is comparable to previous studies of FSL-assisted PKP and DALK. 11,14 Stepped corneal trephination has the advantage of creating a larger surface area at the graft-host interface, leading to improved wound apposition, faster woundhealing, and allowing earlier suture removal. 7,8,11,13 With the advent of FSL in keratoplasty, customised configurations could be created with speed and with great precision.…”

“…Both cases had wide anterior lamella (9.3 and 8.5 mm) to avoid suturing into ectatic corneal tissue and pre-existing corneal neovascularizations. The close proximity between the limbus and the wider anterior lamella of the mushroomshaped corneal graft was speculated to be reason behind the higher rate of stromal rejection as previously observed by Feizi et al 29 and Shehadeh-Mashor et al 14 In summary, our study showed the potential of FSL-assisted mushroom-configuration keratoplasty in the management of patients with stage IV advanced keratoconus, and the described AMID could further enhance the post-keratoplasty refractive and astigmatic outcomes. Future studies with larger multicentre cohorts would help to determine the preferred surgical technique in this particular subgroup of patients.…”

“…Moreover, in our experience, mushroom configuration allows simpler intraoperative conversion from DALK to PKP; therefore, we prefer this configuration for cases of advanced keratoconus, where the risk of intraoperative conversion would be higher. Outcomes of FSL-assisted mushroom-configuration DALK were previously reported by Rootman et al 13,14 Nineteen patients underwent FSL-assisted mushroom DALK, with eight completing follow-up for more than a year. The mean minimum preoperative pachymetry was 542 μm (range: 441-628 μm).…”

“…9,10 In DALKs, FSL-assisted mushroom-shaped keratoplasty also produces faster visual recovery, allowing earlier suture removal and refractive outcome comparable to manual PKP or FSL-assisted lamellar or PKP. [11][12][13][14][15] Lu et al 16 indicated that FSL-assisted DALK could improve uncorrected and best spectacle corrected visual acuity in patients with keratoconus because of the precise cutting of the donor corneal edge profile and the recipient bed. This approach, although in a small cohort, showed a safe and effective surgical choice in the treatment of keratoconus.…”