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

Purpose: To review the long-term outcomes after femtosecond laser (FSL)–assisted mushroom configuration deep anterior lamellar keratoplasty (DALK). Methods: Noncomparative case series of 19 eyes from 19 patients who underwent FSL-assisted mushroom configuration DALK. Results: Data were available for 14 eyes at 1 month, for 14 at 3 months, for 16 at 6 months, for 10 at 9 months, and for 8 at 1 year. Preoperative mean best-corrected visual acuity was 20/108 (range: 20/30–20/400). At 3 months, the mean best-corrected visual acuity was 20/46 (range: 20/25–20/250), and at a mean final follow-up of 13 months (range: 6–29) it was 20/35 (range: 20/15–20/200). The greatest change in mean spherical equivalent was at 3 months [−2.29 diopters (D), range: −7.38 to +3.38 D; from −9.54 D, range: −20.00 to +3.38 D, preoperatively]. There was 56% reduction in mean keratometric cylinder at 6 months (4.00 D, range: 1.04–8.75 D; from 9.13 D, range: 0.50–18.75 D, preoperatively). Complications included 3 cases (15.8%) of small Descemet membrane perforation, none of which required conversion to penetrating keratoplasty; 3 cases (15.8%) of stromal rejection that resolved with topical steroids; and 6 cases (31.6%) of steroid-related intraocular pressure rise that were treated with topical medications. Selective suture removal was initiated a mean of 3.5 months (range: 1.5–6 months) after surgery. Conclusions: 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.