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A variation of the femtosecond laser–assisted sutureless anterior lamellar keratoplasty technique using a femtosecond laser incision for surgical management of anterior corneal disease is described. Six patients with corneal scars were treated with the laser to create a horizontal lamellar bed interface in the cornea of the donor and recipient eyes, with a manual partial-thickness vertical trephination to complete the excisions. This technique allows matching of donor and host tissue dimensions with precise tissue apposition and greater surface area for healing. No intraoperative adverse events were observed. One patient developed epithelial ingrowth, requiring a successful surgical intervention.