Investigation of Femtosecond Laser–Enabled Keratoplasty Wound Geometry Using Optical Coherence Tomography

Purpose: To measure the wound geometry after femtosecond laser-enabled keratoplasty (FLEK) using optical coherence tomography (OCT). Design: Prospective nonrandomized clinical study and laboratory study. Participants: Patients who were candidates for penetrating keratoplasty at an academic referral center. Methods: Wound architecture was measured and analyzed by OCT in 8 eyes of 8 consecutive patients who underwent FLEK. Femtosecond laser lamellar cuts were performed on 3 eye bank corneas, and the wound diameters were measured by OCT. Results: Sutures were completely removed on average at 1 month per decade of age after surgery. No cases of wound dehiscence were noted, and graft-host tissue apposition appeared excellent on OCT. The mean spectacle-corrected visual acuity 1 month after suture removal was 20/35, and mean astigmatism was 5.0 diopters by manifest refraction and 8.7 diopters by computerized topography. The measured graft diameter was smaller than the laser setting by 2.5% (P = 0.007). The cut diameters of the eye bank corneas were also slightly smaller than the laser setting. Conclusions: FLEK offers benefits of rapid wound healing and predictable wound geometry. The measured wound geometry agreed well with laser setting other than a small systematic deviation that could be explained by the mechanics of corneal applanation during the laser cut. OCT is a useful tool to measure the actual graft diameter after FLEK.