En Bloc Transepithelial Anterior Lenticule Excision Using A Femtosecond Laser Vs Excimer Ptk For Corneal Dystrophy

To demonstrate the therapeutic utility of femtosecond laser technology for anterior corneal dystrophy by comparing a femtosecond-laser–created transepithelial anterior lenticule excision with standard excimer-based phototherapeutic keratectomy (PTK) using masking fluid in a contralateral-eye design.

Single-center cornea/refractive service.

 A 70-year-old pseudophakic woman with bilateral visually significant anterior corneal dystrophy underwent staged bilateral surface-smoothing procedures. One eye received conventional excimer PTK with masking fluid to regularize the anterior stromal surface. The fellow eye underwent a femtosecond laser–assisted therapeutic anterior keratectomy in which a transepithelial anterior lenticule was created with a 0-µm cap and removed en bloc. Postoperative medication regimens and bandage contact lens management were standardized between eyes. Primary outcomes were epithelial healing time, early stromal response (haze/inflammation), and functional visual recovery. A second supporting case is presented in which both eyes were treated in a single session using a combined femtosecond + excimer strategy.

Both eyes demonstrated improved visual function and symptomatic improvement. The femtosecond-treated eye exhibited faster epithelial closure (2 days vs 4 days) and less early stromal reaction compared with the excimer PTK eye, with earlier subjective visual recovery. No intraoperative complications occurred. In the additional bilateral combined femto+excimer case, rapid re-epithelialization and clinically meaningful improvement in surface regularity were similarly observed. 

In this contralateral-eye experience, femtosecond-assisted treatment showed faster healing with reduced early stromal reactivity versus standard masked PTK. Combined femto+excimer treatment may further expand the therapeutic toolkit for anterior corneal pathology.