{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:56:20Z","timestamp":1789588580533,"version":"build-2803163510"},"reference-count":46,"publisher":"Bentham Science Publishers Ltd.","issue":"1","license":[{"start":{"date-parts":[[2017,7,31]],"date-time":"2017-07-31T00:00:00Z","timestamp":1501459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/legalcode"}],"content-domain":{"domain":["openophthalmologyjournal.com","benthamopen.com"],"crossmark-restriction":true},"short-container-title":["TOOPHTJ"],"published-print":{"date-parts":[[2017,7,31]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p>In case of keratoconus, rigid gas-permeable contact lenses as the correction method of first choice allow for a good visual acuity for quite some time. In a severe stage of the disease with major cone-shaped protrusion of the cornea, even specially designed keratoconus contact lenses are no more tolerated. In case of existing contraindications for intrastromal ring segments, corneal transplantation typically has a very good prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>In case of advanced keratoconus \u2013 especially after corneal hydrops due to rupture of Descemet\u2019s membrane \u2013 penetrating keratoplasty (PKP) still is the surgical method of first choice. Noncontact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and those with repeat grafts in case of \u201ckeratoconus recurrences\u201d due to small grafts with thin host cornea. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved with a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually depending on corneal size (\u201eas large as possible \u2013 as small as necessary\u201c). Limbal centration will be preferred intraoperatively due to optical displacement of the pupil. During the last 10 years femtosecond laser trephination has been introduced from the USA as a potentially advantageous approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces \u201cvertical tilt\u201d and \u201chorizontal torsion\u201d of the graft in the recipient bed, thus resulting in significantly less \u201call-sutures-out\u201d keratometric astigmatism (2.8 vs. 5.7 D), higher regularity of the topography (SRI 0.80 vs. 0.98) and better visual acuity (0.80 vs. 0.63) in contrast to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. Refractive outcomes of femtosecond laser keratoplasty, however, resemble that of the motor trephine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth\/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination with intraoperative pitfalls and high postoperative astigmatism.<\/jats:p><\/jats:sec>","DOI":"10.2174\/1874364101711010225","type":"journal-article","created":{"date-parts":[[2017,8,4]],"date-time":"2017-08-04T12:04:23Z","timestamp":1501848263000},"page":"225-240","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Penetrating Keratoplasty for Keratoconus \u2013 Excimer Versus Femtosecond Laser Trephination"],"prefix":"10.2174","volume":"11","author":[{"given":"Berthold","family":"Seitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achim","family":"Langenbucher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Janunts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moatasem","family":"El-Husseiny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Szentm\u00e1ry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1007\/s00347-013-2819-9","volume":"110","author":"Kl\u00fchspies U.","year":"2013","unstructured":"Kl\u00fchspies U, Grunder A, Goebels S, Schirra F, Seitz B. 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