Laser-Assisted Penetrating Keratoplasty: 1-Year Results in Patients Using a Laser-Welded Anvil-Profiled Graft

Purpose: To describe a new laser-assisted penetrating keratoplasty, combining a femtosecond "anvil"-like trephination pattern with the laser welding procedure. Design: Cohort Prospective Study, 1 year follow up (June 2011- January 2013). Methods: This study was performed at Misericordia e Dolce Public Hospital, Prato, Italy. 24 eyes out of 22 patients underwent penetrating keratoplasty: 4 had granular dystrophy, 12 keratoconus in its final stages, 3 post-herpetic leukoma and 5 corneal scars. A femtosecond laser was used to create "anvil"-profiled cuts in donor and recipient corneas. Diode laser welding was performed, supporting standard suturing. All patients were evaluated for corrected distance visual acuity, pachymetry, manifest astigmatism and endothelial cell density after 1, 3, 6 and 12 months. Results: Mean post-operative corrected visual acuity (logMAR, mean ± SD) was 0.48±0.23, 0.30±0.18, 0.18±0.13 and 0.13±0.16 at 1, 3, 6, 12 months, respectively. At the same follow up times mean pachymetry was 537±57 ?m, 533±74 ?m, 528±72 ?m and 529±58 µm; mean endothelial cell density was 1945±371cell/mm2, 1881±410 cell/mm2, 1781±401 cell/mm2 and 1730±376 cell/mm2. Mean manifest and topographic post-operative astigmatism (measured in diopters) were: 3.6±2.5 and 4.65±2.57 at 1 month, 2.93±2.34 and 4.79±2.85 at 3 months, 2.82±1.75 and 3.44±2.28 at 6 months and 2.08±1.25 and 2.73±2.01 at 12 months, respectively. All surgical operations were successful and without intraoperative complications. Conclusions: The use of the "anvil" trephination profile was effective to perform laser-assisted penetrating keratoplasty. The large donor/recipient interface enables the laser welding procedure and good preservation of the recipient's endothelial cell pool.