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Femtosecond dovetail penetrating keratoplasty: surgical technique and case report
  1. J Lee,
  2. J Winokur,
  3. J Hallak,
  4. D T Azar
  1. Department of Ophthalmology and Visual Sciences, Illinois Eye Ear Infirmary, University of Illinois, Chicago, Illinois, USA
  1. Dr D T Azar, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA; dazar{at}


Aim: To report a dovetail configuration for femtosecond-enabled penetrating keratoplasty (PK) with the corresponding laser parameters and suturing technique.

Methods: A 40-year-old man, with a history of penetrating corneal injury as a child, underwent femtosecond-enabled dovetail keratoplasty, anterior vitrectomy and secondary intraocular lens suturing to repair his corneal scar and aphakia. A partial thickness dovetail pattern was performed in the recipient cornea using the femotsecond laser. The posterior side-cut was initiated ∼100 μm anterior to the Descemet membrane and extended obliquely towards the outer edge of a ring lamellar cut, positioned at ∼300 μm stromal depth. The anterior side-cut was extended from the internal edge of the ring lamellar cut to the corneal surface. Using an artificial chamber, the femtosecond laser was used to create a full-thickness 0.2 mm oversized femtosecond-enabled dovetail trephination with similar anterior lamellar depth (∼300 μm). Wound closure, using interrupted 10–0 nylon sutures, was guided by preplaced radial alignment laser microincisions and tongue-in-groove midstromal suture positioning.

Results and discussion: Excellent alignment and stability of the donor and recipient tissue were observed immediately postoperatively and 5 months after surgery. The feasibility of the “dovetail” pattern of PK and the tongue-in-groove suture positioning is demonstrated.

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  • Competing interests: None.

  • Funding: NIH EY10101 (DTA), P30-001792 (DTA), and an unrestricted departmental support from Research to Prevent Blindness (New York).

  • Patient consent: Obtained.