Excimer vs Femtosecond laser for nonmechanical keratoplasty – Where are the true benefits?

Abstract

AbstractPurpose: To compare the intraoperative feasibility and postoperative outcome of the excimer (EXL) and femtosecond laser (FSL) for penetrating keratoplasty (PKP). Methods: Since 1989 more than 3500 non‐contact nonmechanical PKPs using the Zeiss‐Meditec MEL70® 193 nm EXL along metal masks with eight "orientation teeth/notches" (PKP) were performed. Since 2006 various groups applied the FSL for PKP with various 3D‐configurations. Results: The technique of EXL PKP may improve donor and recipient centration, reduce "vertical tilt" and "horizontal torsion" of the graft in the recipient bed, thus resulting in significantly less "all‐sutures‐out" astigmatism, higher regularity of the topography and better visual acuity. Clinical results of FSL PKP ‐ requiring variable amounts of applanation thus causing distortion of corneal tissue ‐ are still very limited and not yet finally convincing. Conclusions: Because of undisputed clinical advantages, especially in eyes with keratoconus, EXL trephination is still favoured in Homburg/Saar in daily practise. To determine potential benefits of FSL over EXL PKP, a prospective randomized study for keratoconus and Fuchs dystrophy is ongoing in Homburg/Saar.