Clinical Study Of Femtosecond Laser-assisted Mushroom-like Incision Penetrating Keratoplasty

Objective To evaluate the efficacy and safety of femtosecond laser-assisted penetrating keratoplasty(FS-PKP)as compared with traditional penetrating keratoplasty(T-PKP).Methods We retrospectively analysed medical charts of the FS-PKP group(58 eyes from 57 patients)and the T-PKP group(40 eyes from 40 patients)from March 2014 to January 2017.Primary diseases include corneal ulcers,keratoconus,corneal leukoplakia,corneal epithelial decompensation,corneal degeneration.The mushroom-shaped incision corneal grafts were implanted with femtosecond laser In the FS-PKP group,while the implantation in the T-PKP group was made by negative pressure ring drilling;and the postoperative treatments were exactly the same.At an average follow-up of 14.46 ± 7.96 months,uncorrected vision(UCVA),best corrected visual acuity(BCVA),equivalent spherical surface(SE),corneal astigmatism(CA),corneal endothelium density(CD)and surgical complications were respectively assessed 1week,1month,3months,6months,10 months,12months,18 months and 24 months after operation.Results Postoperative visual acuity in both groups have varying degrees of improvement.Comparison with the UCVA of T-PKP group: UCVA of FS-PKP group was 3.66±0.55 at 1week after operation,with no statistically significant difference(P>0.1);UCVA of FS-PKP group were 3.91±0.45?3.93±0.43?4.02±0.40?4.11±0.32?4.06±0.36?4.08±0.44?4.16±0.35 1m?3m?6m?10m?18m and 24 m after operation,respectively,with statistically significant difference(all P<0.05).Comparison with the BCVA of FS-PKP group were 4.11±0.50?4.17±0.45?4.24±0.41?4.35±0.38?4.36±0.45?4.36±0.59 1w?1m?3m?6m?10m?12m?18m and 24 m after operation, respectively,with statistically significant difference(all P<0.05).Comparison with the CA of T-PKP group:CA of FS-PKP group were 3.87±0.58?4.10±0.52?4.17±0.46?4.23±0.42?4.32±0.38?4.34±0.42?4.37±0.49?4.44±0.28 1w?1m?3m?6m?10m?12m?18m and 24 m after operation,with no statistically significant difference(P>0.05);CA of FS-PKP group were 3.01±1.61?3.48±2.10?3.23±2.11?2.94±1.57?2.89±1.59?3.25±2.23?3.59±2.67?2.84±1.72 1w?1m?3m?6m?10m?12m?18m and 24 m after operation,respectively,with statistically significant difference(all P<0.05).Comparison with the SE of T-PKP group:SE of FS-PKP group were0.98±3.03?1.75±3.00?1.43±2.86?0.50±3.03?1.03±3.21?-0.01±3.51?0.18±2.98?0.37±2.93 1w?1m?3m?6m?10m?12m?18m and 24 m after operation,respectively,with no statistically significant difference(all P>0.1).No significance was found in the CD of both groups after operation(all P>0.05).Comparison with the surgical complications of T-PKP group: Incidence rate of high intraocular pressure?rejection and cracked anastomosis of FS-PKP group was 8.3%(4/48)?2.1%(1/48)and 4.2%(2/48),respectively,with no statistically significant difference(all P>0.1).Conclusion Compared with the traditional penetrating keratoplasty,the femtosecond laser-assisted penetrating keratoplasty with mushroom incision have visual acuity recovered ealier,corneal astigmatism reduced significantly and better visual effect,demonstrating the clinical superiority of this new technique.