LAUSR

PURPOSE To compare the clinical outcomes in femtosecond laser assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting. DESIGN Single-centre, comparative, retrospective interventional case series. METHODS . POPULATION Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1st 2015 to September 1st 2018 and big-bubble M-DALK from September 1st, 2012, to September 31st, 2016. SETTING Moorfields Eye Hospital, London. OBSERVATIONS Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MAIN OUTCOME MEASURES Rate of Intra operative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40. RESULTS We analysed 58 eyes of 55 patient who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15/58 (25.9%) of F-DALK cases compared 148/326 (45.4%) of M-DALK cases (p=0.006). Intraoperative conversion to PK was carried out in 2/58 (3.4%) of F-DALK cases compared to 80/326 (24.5%) of M-DALK cases (p=0.001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15±7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9±10.6 months) (p=0.825). CONCLUSION Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.