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To evaluate the outcomes and safety of lamellar keratoplasty (LK) assisted by a femtosecond laser.Twenty-one eyes of 21 patients affected by different corneal pathologies (5 posttraumatic corneal scar, 3 postkeratitis corneal leucoma, and 13 keratoconus) underwent LK procedures by using a femtosecond laser. The mean thinnest corneal thickness, evaluated with ultrasound corneal pachymetry and with confocal microscopy, was 434.19 ± 62.60 (SD) μm (range, 333-548 μm). Mean preoperative uncorrected visual acuity was 0.09 ± 0.28 SD and mean preoperative best spectacle-corrected visual acuity was 0.28 ± 0.15 SD. A femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The donor corneal lamella diameters were 0.20-mm larger and thicker than the recipient to restore a physiologic corneal thickness and shape: mean donor diameter was 8.34 ± 0.28 mm (range, 8.2-8.7 mm) and mean thickness was 352 ± 40.27 μm (range, 220-400 μm). Mean follow-up was 20.86 ± 5.76 months (range, 12-30 months).Early postoperative evaluation showed a clear graft in all cases. A normal corneal pattern topography and a physiologic thickness (mean corneal pachymetry, 542.48 ± 33.20 μm) and transparency were restored. Twelve months after surgery, the mean postoperative uncorrected visual acuity was 0.45 ± 0.34 SD, and the mean best spectacle-corrected visual acuity was 0.63 ± 0.16 SD.Although the numbers in our study are small, our early results indicate that femtosecond laser-assisted lamellar keratoplasty shows promise as a safe and effective surgical choice in the treatment of various corneal pathologies.