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Femtosecond Laser-Assisted Mushroom Configuration Deep Anterior Lamellar Keratoplasty

Chan, Clara C MD; Ritenour, Rusty J MD, FRCSC; Kumar, Nikhil L BMed, MPH; Sansanayudh, Wiwan MD; Rootman, David S MD, FRCSC

doi: 10.1097/ICO.0b013e3181b77873
Clinical Science

Purpose: To review patient outcomes after femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty.

Methods: Seven eyes of seven patients with a mean age of 30 years underwent femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty from April 2008 to September 2008. Patients had keratoconus, corneal ectasia or scarring. Set for 100 μm of residual cornea, the femtosecond laser was used to create a mushroom-shaped recipient bed and donor button (having a larger anterior than posterior diameter). The posterior central lamella was manually dissected using Melles technique.

Results: Mean follow up was 4 months (range, 3-6.5 months). Preoperative mean best-corrected visual acuity was 20/95 (range, 20/40-20/400). Intraoperative complications included two cases (28.6%) of small Descemet membrane perforation. Postoperatively, there was one case of stromal rejection that resolved with topical steroids and two cases of steroid-related intraocular pressure rise that were treated with a prostaglandin analog. At 3 months, mean best-corrected visual acuity was 20/40 (range, 20/25-20/60), mean spherical equivalent refraction was −3.21 D (range, −6.75 D to plano), mean cylindrical refractive error was 3.57 D (range, 1.5-7 D), and mean keratometric cylinder measured 5.56 D (range, 3.79-7.00 D). Selective suture removal occurred in six patients (86%) at a mean of 3.8 months (range, 2-6 months) postoperatively.

Conclusions: This preliminary series demonstrates that the use of the femtosecond laser to perform corneal cuts in a mushroom configuration for deep anterior lamellar keratoplasty is feasible. The mechanical stability and wound healing advantages for stepped corneal wounds should be considered in lamellar surgery.

From the *Toronto Western Hospital, Department of Ophthalmology, University Health Network, University of Toronto, Toronto, Ontario, Canada; and †Yonge Eglinton Laser Eye and Cosmetic Centre, Toronto, Ontario, Canada.

Received for publication December 5, 2008; revision received April 29, 2009; accepted July 8, 2009.

Reprints: Clara C. Chan, MD, c/o Dr. David S. Rootman, 399 Bathurst Street, Toronto Western Hospital, East Wing 7th Floor, Toronto, Ontario M5T 2S8, Canada (e-mail:

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