Abstract
To evaluate the feasibility of femtosecond laser-assisted repeat penetrating keratoplasty (PK) in eyes having undergone corneal graft, thus presenting intracorneal scar tissue. Repeat PK was performed with femtosecond laser (Intralase FS TM System; Abbott Medical Optics, Inc, Santa Ana, CA) creating a "top-hat" or "mushroom" configuration. Four patients were included in this study. Indications for repeat PK included recurrent keratoconus (n = 2), endothelial graft failure (n = 1) after conventional PK, and low visual acuity after lamellar keratoplasty (n = 1). Eyes were trephinated within or including the first graft. Complete uneventful femtosecond laser-assisted trephination occurred in 3 of 4 patients. In 1 patient, laser trephination had to be completed manually because of tissue bridges. Histological examination of the host corneas revealed straight cutting edges according to the programmed shape. Visual outcome in all patients was reduced because of uncontrolled intraocular pressure, postoperative trauma, and irregular astigmatism. This small case series demonstrates that repeat PK with femtosecond laser is technically a suitable method when the peripheral cornea is sufficiently clear.
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