Femtosecond laser-assisted decagonal deep anterior lamellar keratoplasty

Objective: To assess the use of a new polygonal trephination pattern for deep anterior lamellar keratoplasty (DALK) assisted by femtosecond laser. Design: Prospective, nonrandomized clinical study. Methods: Twenty-four eyes underwent decagonal DALK. All except 1 had advanced keratoconus. A laser was used to create decagonal cuts on both donor and recipient corneas. All patients were assessed for uncorrected visual acuity, best spectacle corrected visual acuity (BCVA), and keratometry by Pentacam pre- and postoperatively. Results: All eyes were treated successfully without intraoperative complications. All patients were followed for 18 months. Mean SD of postoperative BCVA was 0.26 +/- 0.16 (logarithm of minimal angle of resolution), and there was a significant improvement in BCVA after 6 months. At 18 months, mean SD postoperative average K was 44.48 +/- 0.87 D, which was significantly lower than preoperative average K (58.42 12.1). Postoperative astigmatism at 18 months (mean +/- SD: 1.82 +/- 0.67) was significantly lower than that at 6 months (mean +/- SD: 3.27 +/- 0.81) (p = 0.001). Conclusions: Use of the decagonal trephination profile was effective to perform DALK. This study showed promising visual and refractive results. Longer follow-up, larger pool of patients, and comparative studies are necessary to determine advantages and optimal surgical settings of this technique.