AIM: To evaluate the clinical effects and safety of femtosecond laser-assisted endothelial keratoplasty in bullous keratopathy.

METHODS:It was a retrospective case series study. Fifteen consecutive patients(16 eyes)with bullous keratopathy at Nanjing General Hospital of Nanjing Military Command underwent Descemet's stripping endothelial keratoplasty whose donor grafts were dissected by a femtosecond laser from March 2013 to February 2014.The corneal irritation symptoms and the attachment of endothelial grafts were evaluated during the 12mo follow-up period. Clinical data of the best-corrected visual acuity, intraocular pressure, anterior segment optical coherence tomography and endothelial cell count were reviewed.

RESULTS: The surgical procedures for all the cases were successful and no intraoperative complication developed. The corneal irritation symptoms began relieving on 1d postoperatively and fully recovered in 3wk and never relapsed during the follow-up period. The grafts were well attached to the host except for one dislocation(6%)which was relocated and well attached afterward. Fluid leakage between the local graft-host interface occurred in three eyes(19%)and absorbed spontaneously in 3wk.At postoperative 1mo, the corneal epithelium became smooth and the edema of corneal stroma dissolved. The central corneal thickness thinned out from preoperative 811±137.55μm to postoperative 638±86.51μm. During the follow-up period, acute rejection and graft endothelial decompensation was observed in one eye(6%)respectively. At the final follow-up, endothelial cell density was 1 687±507cells/mm².

CONCLUSION:The femtosecond laser-assisted Descemet's stripping endothelial keratoplasty is a safe and effective technique for corneal endothelial decompensation, which may yield thin individualized grafts efficiently and precisely.