Femtosecond Laser-Assisted Tuck-In Penetrating Keratoplasty for Advanced Keratoglobus With Endothelial Damage

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Purpose:To describe the outcomes of femtosecond laser-assisted tuck-in penetrating keratoplasty as a single-step surgical procedure for visual and anatomical rehabilitation of patients with severe keratoglobus (KTG) and endothelial damage.Methods:Two eyes of a 7-year-old patient with bilateral severe KTG and previous corneal hydrops were operated. Assisted by the femtosecond laser, both donor and recipient corneas were prepared. An 8.5-mm full-thickness donor tissue with a peripheral partial-thickness rim of 1.25 mm was sutured into an 8.5-mm recipient bed with a previously dissected intralamellar peripheral pocket up to the limbus. The graft was secured with 16 interrupted 10-0 nylon sutures and the peripheral donor rim tucked into the host stromal pocket.Results:Six months after surgery, both grafts remained healthy and clear. One eye developed mild postoperative ocular hypertension. No intraoperative or other postoperative complications were observed. Corrected distance visual acuity was 20/50 in both eyes, with complete functional rehabilitation of the patient. Restoration of the peripheral corneal thickness was observed in the pachymetric map.Conclusions:Femtosecond laser-assisted tuck-in penetrating keratoplasty can provide excellent anatomical and functional rehabilitation of patients with severe KTG and endothelial damage, through a single-step surgical procedure and a single donor cornea per eye. The femtosecond laser permits accurate dissection of these already thin corneas without inadvertent perforation risk.

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