To compare outcomes of femtosecond laser-enabled deep anterior lamellar keratoplasty (IE-DALK) versus manual trephine using deep anterior lamellar keratoplasty (Manual DALK, M-DALK).

Seventeen eyes from 17 patients underwent manual deep anterior lamellar keratoplasty, and femtosecond laser-enabled deep anterior lamellar keratoplasty was performed in 13 eyes of 13 patients. Postoperative clinical outcomes such as best corrected visual acuity, refractive astigmatism, keratometric astigmatism, endothelial cell density were compared between the two groups.

The mean log MAR best spectacle-corrected visual acuity (BSCVA) was 0.31 ± 0.17, 0.23 ± 0.15, 0.18 ± 0.14 in the IE-DALK group, and 0.55 ± 0.41, 0.45 ± 0.28, 0.35 ± 0.22 ( p = 0.056, p = 0.025, p = 0.313) in the M-DALK group at postoperative 2, 4, and 6 months respectively. The mean keratometric cylinder was 5.35 ± 1.57, 4.24 ± 1.97, 3.65 ± 1.31 in the IE-DALK, 8.32 ± 2.75, 6.80 ± 2.50, 4.54 ± 1.25 ( p = 0.031, p = 0.041, p = 0.370) in the M-DALK group at postoperative 2, 4, and 6 months respectively. Endothelial cell counts in the two groups did not differ significantly at postoperative 6 months.

The IE-DALK showed better results in BSCVA and keratometric astigmatism in the early postoperative period, in comparison with the M-DALK, and can be considered as a valuable method in deep anterior lamellar keratoplasty.