ReviewClinical ophthalmology (Auckland, N.Z.)2026
Femtosecond Laser-Assisted Keratoplasty: A Narrative Review of Technological Evolution, Clinical Evidence, Implementation and Future Directions.
Review in Clinical ophthalmology (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Femtosecond laser-assisted keratoplasty (FLAK) enables programmable photodisruption, customized graft-host configurations, and image-guided corneal reconstruction. This narrative review synthesizes 107 scholarly publications spanning 2003-2026, identified through PubMed/MEDLINE and reference lists, alongside regulatory documentation. It examines mechanisms, technological development, clinical evidence, emerging approaches, and implementation. Evidence is interpreted primarily through final best-corrected visual acuity, graft survival, and reintervention, with incision precision treated as a surrogate. In penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), femtosecond laser (FSL) assistance may improve wound architecture and selected early outcomes, but durable patient-relevant superiority remains unproven. Randomized endothelial keratoplasty evidence identified poorer visual acuity and greater endothelial loss with early FSL-assisted donor preparation, despite reduced astigmatism. Selected Descemet membrane endothelial keratoplasty (DMEK) and reconstructive applications remain promising but insufficiently validated. Emerging approaches include stromal lenticule repair, additive reconstruction, limbal transplantation, and scaffold preparation. Their evaluation must separate procedural feasibility from comparative effectiveness. Postoperative healing, suture management, complications, and surgical experience can outweigh initial geometric precision. Historical economic evidence disfavors FSL-assisted endothelial graft preparation; contemporary cost-effectiveness remains uncertain. Selective implementation should consider clinical need, local expertise, shared infrastructure, and equitable access. Future evaluation should prioritize long-term patient outcomes, direct economic comparisons, and multicenter validation of lower-energy platforms, real-time imaging, artificial intelligence-assisted planning, and biomechanically informed incision design.
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