Femtosecond laser-assisted Descemet's stripping endothelial keratoplasty: a prospective study of 6-month visual outcomes, corneal thickness and endothelial cell loss.

PURPOSE: To report 6-month outcomes of visual acuity, the corneal thickness and endothelial cell density (ECD) in patients undergoing femtosecond laser-assisted Descemet's stripping endothelial keratoplasty (FS-DSEK). METHODS: This prospective, consecutive, interventional series examined 25 eyes of 25 patients who underwent FS-DSEK for Fuchs endothelial dystrophy and bullous keratopathy. The pre-cut corneal endothelial graft thickness (CET) was 150 microm. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), donor CET, recipient corneal stromal thickness (CST) and ECD were assessed at 1 week and 1, 2, 3 and 6 months postoperatively. RESULTS: The mean BCVA at 6 months was 0.76 +/- 0.35 logMAR units, improving from 1.54 +/- 0.52 logMAR. CCT decreased significantly, from 759.8 +/- 152.4 microm at 1 week to 631.7 +/- 79.7 microm at 6 months (P = 0.001) postoperatively. CET recovered to 153.4 +/- 33.7 microm (P = 0.076) at 6 months as pre-cut status. The CST decreased from 561.5 +/- 96.3 microm at 1 week to 479.7 +/- 57.9 microm at 6 months (P < 0.001). Preoperatively, the donor ECD was 2747.6 +/- 255.4 cells/mm(2), and the ECD decreased to 1729.1 +/- 562.9 cells/mm(2) at 6 months, for a peak ECD loss of 36.86%. A greater decrease in CST observed from 1 week to 6 months postoperatively correlated with a lower ECD loss (P = 0.019) and a lower preoperative ECD (P = 0.012). However, a thinner CET correlated with a higher preoperative ECD (P = 0.028). CONCLUSIONS: FS-DSEK is a safe and effective surgical alternative for corneal endothelial decompensation. The donor ECD and its changes could be used as predictive factors for the improvement of CST and CET.