Current concepts and recent trends in endothelial keratoplasty

Table 3 Comparison of outcomes of femtolaser-assisted endothelial keratoplasty procedures with conventional manual procedures

Ref.	Topic	Graft survival and graft-related complications	Visual Outcomes
Malyugin et al[87], 2019	FS-DSEK vs DSAEK	The graft survival was 89.5% in the femtosecond laser-assisted DSEK (FS-DSEK) group and 95% in the microkeratome-assisted DSAEK group, but the endothelial cell loss was higher in the FS-DSEK group compared to the DSAEK group at 12 months	The visual acuity outcomes were similar between the two groups at long-term follow-up
Einan-Lifshitz et al[86], 2017	FS-DMEK vs Manual DMEK (M-DMEK)	The graft survival, as indicated by the endothelial cell loss (24% vs 29%) and graft detachment rates (0% vs 20%), was better in the FE-DMEK group compared to the M-DMEK group
Sorkin et al[89], 2020	F-DMEK and M-DMEK	Significantly lower rates of graft detachment (6.25% vs 35.6%) and need for rebubbling (6.25% vs 33.3%) in the F-DMEK group 3) Significantly lower rates of endothelial cell loss in the F-DMEK group at 1 and 2 years, 4) Numerically lower graft failure rate in the F-DMEK group (0% vs 8.9%), though not statistically significant	Comparable visual acuity improvement between F-DMEK and M-DMEK groups over 3 years
Cheng et al[90], 2009	FL-EK and PK	Mean postoperative BCVA was 20/70 ± 2 lines in the FLEK group and 20/44 ± 2 Lines in the PK group (P < 0.001), but the gain in the best corrected visual acuity between the two groups was not significantly different. The endothelial cell loss in the FL-EK and PK group was 65 ± 12% and 23 ± 15% (P < 0.001)	FL-EK reduces postoperative astigmatism but has higher endothelial cell loss compared to PK

FS: Femtosecond; FL: Femtosecond laser; PK: Penetrating keratoplasty; BCVA: Best corrected visual acuity; DMEK: Descemet membrane endothelial keratoplasty; DSAEK: Descemet stripping automated endothelial keratoplasty.