Effect of femtosecond-assisted vs manual descemetorhexis on the posterior corneal surface after DMEK: A fellow eye comparison

Purpose This study aimed to evaluate anatomical changes in the posterior corneal surface in a cohort of patients who underwent Descemet membrane endothelial keratoplasty (DMEK) with manual descemetorhexis in one eye and femtosecond-assisted descemetorhexis in the fellow eye. Methods In this prospective case series study, morphological changes in the posterior corneal surface of nine patients who underwent DMEK with manual descemetorhexis in one eye and femtosecond-assisted descemetorhexis in the other eye were investigated. Main outcome measures were obtained with Pentacam (Oculus, Weltzar, Germany) and included the best-fit sphere at 4 mm in the posterior surface, asphericity coefficient Q, posterior corneal elevation, posterior simulated keratometry, pachymetry and higher order aberrations. Results The differences in the posterior corneal surface were not statistically significant for any variable nor were their differences in best-corrected visual acuity, refraction or endothelial cell density. A rebubbling procedure was performed for each group. Conclusions The femtosecond descemetorhexis circular cut and asymmetry in the stromal depth of cut did not result in a less favorable outcome than the manual dissection profile in terms of posterior corneal surface irregularity or corneal aberration, and thus on the visual outcome.