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A comparative study of femtosecond laser-assisted versus manual trephination deep anterior lamellar keratoplasty

Poster Details

First Author: M.Laginaf UK

Co Author(s):    D. Ramanathan   T. Poole                 

Abstract Details


Deep anterior lamellar keratoplasty (DALK) surgery is most widely performed using manual trephination and Anwar’s big bubble technique. However, there remains an inherent risk of corneal perforation and conversion to penetrating keratoplasty (PK). The evolution of femtosecond laser (FSL) has led to increased precision and reproducibility of corneal cuts which could have some advantages over manual trephination. The aim of this study is to compare the outcomes and safety of femtosecond laser-assisted DALK (FSL-DALK) with manual trephination DALK (MT-DALK).


Frimley Health NHS Foundation Trust. Surrey, England, UK.


A retrospective comparative study of FSL-DALK versus MT-DALK was performed from data obtained between October 2013 and December 2019. Surgeries were performed by a combination of 1 corneal consultant and 3 corneal fellows. Anwar’s big bubble technique was utilised in all cases. FSL-DALK was performed using VICTUS® Femtosecond-laser Platform (Bausch and Lomb) for both host and donor cornea. Primary outcomes were conversion to PK and micro-perforation(s) requiring air/gas intracameral injection. Secondary outcomes were post-operative uncorrected (UCVA) and best corrected visual acuities (BCVA). Any adverse events were recorded.


27 patients were identified and included in the study (14 FSL-DALK, 13 MT-DALK). 92.6% of patients were male and mean age was 43 years FSL-DALK, 40 years MT-DALK. The most frequent indication was keratoconus (78.6% FSL-DALK, 84.6% MT-DALK). Conversion to PK rate was 21.4% FSL-DALK, and 46.2% MT-DALK (p=0.17). Micro-perforations in non-converted cases occurred in 36.4% FSL-DALK and 14.2% MT-DALK groups (p=0.31). All were successfully treated with air or Sulfur hexafluoride intracameral injection. Mean 6-month postoperative LogMAR BCVA was 0.38 FSL-DALK and 0.33 MT-DALK (p=0.35). There were no adverse events. Post-operative refractive data and endothelial cell count was not available.


Our study suggests a trend of lower conversion to PK rate with FSL-DALK when compared to MT-DALK, and a higher rate of micro-perforation in the FSL-DALK group. However, these results were not statistically significant. Visual outcomes were similar between the two groups and there were no safety concerns for FSL-DALK. Further studies with larger sample size, inclusive of refractive data, are required to ascertain superiority of FS-DALK over MT-DALK.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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