Success of femtosecond laser-assisted deep anterior lamellar keratoplasty (Femto-DALK): a clinical case series of 42 eyes using an intraoperative optical coherence tomography (iOCT)-guided laser-generated pre-descemet tunnel

PURPOSE: To evaluate the success of Femto-DALK with an iOCT-guided generated intrastromal pre-Descemet tunnel. METHODS: This monocentric, retrospective study evaluated all patients treated with Femto-DALK between January 2020 and December 2023 at the Department of Ophthalmology at the University of Düsseldorf (Germany). The iOCT-guided tunnel was generated 30 microns anterior of Descemet's membrane. BB generation, surgery time and conversion to penetrating keratoplasty (PK) were analyzed. RESULTS: A total of 42 eyes of 41 patients were identified. BB creation was successful in 78.6% of cases. Intraoperative conversion to PK was necessary in 28.6% of the eyes and microperforation of Descemet's membrane (DM) occurred in 16.7% of completed DALKs. Mean operation time was 118.6 ± 40.68 min. Among successful Femto-DALKs (n = 30), double anterior chamber was observed in 26.7%, and re-bubbling was needed in 23.3%. Re-keratoplasty was performed in one eye (3.3%). CONCLUSION: Femto-DALK with an iOCT-guided pre-Descemet tunnel generation is a feasible technique that achieves BB success rates comparable to the upper range reported for manual dissection, without a clear demonstrated improvement over manual technique.