Trends in Corneal Transplantation Revealed by KONOS and Health Insurance Review and Assessment Service Annual Reports

Purpose@#To analyze trends in corneal transplantation surgery and determine the number of domestic and imported corneal grafts used in South Korea.Method: The total number of keratoplasties and number of each individual surgical procedure conducted in 2010 and 2020 were identified using Health Insurance Review and Assessment Service data. The number of keratoplasties using domestic corneas in 2010 and 2020 was determined from the annual report of the Korean Network for Organ Sharing (KONOS). The number of keratoplasties using imported corneas was calculated by subtracting the number of keratoplasties using domestic corneas from the total number of keratoplasties. @*Results@#In 2010, 802 keratoplasties were performed in Korea, of which 299 (37.3%) used imported corneas; 715 (89.2%) were penetrating keratoplasties and 87 (10.8%) were anterior lamellar keratoplasties. In 2020, 911 keratoplasties were done in Korea and 564 (61.9%) used imported corneas; 541 (59.4%) were penetrating keratoplasties, 60 (6.6%) were anterior lamellar keratoplasties, and 310 (34.0%) were endothelial keratoplasties. From 2010 to 2020, the number of penetrating keratoplasties in Korea decreased, while the numbers of endothelial keratoplasties and keratoplasties using imported corneas increased. @*Conclusions@#There was a 30% decrease in the number of penetrating keratoplasties from 2010 to 2020, and a 30% increase in the numbers of endothelial keratoplasties and keratoplasties using imported corneas. The proportions of endothelial keratoplasties and imported corneas have increased steadily in Korea over the last 10 years.

Novel Method Measuring Conjunctival Microvascular Blood Flow Velocity by Zoom-lens, Ultra-high-speed Camera Attached Slit-lamp Biomicroscope

Purpose@#To introduce an intuitive method for measuring conjunctival microvascular blood flow velocity by imaging bulbar conjunctival microvessels using a slit-lamp biomicroscope equipped with a zoom lens and an ultra-high-speed camera. @*Methods@#After obtaining consent from 10 patients (1 male, 9 females) who visited Yeouido St. Mary’s Hospital from August 21, 2020, to June 12, 2021, the patients were examined under a slit lamp microscope equipped with an ultra-high-speed camera and zoom lens. The blood flow in the conjunctival microvessels was photographed. The captured images were analyzed with ImageJ software to measure the blood flow velocity in the conjunctival microvessels, and we investigated whether the blood flow velocity correlated with the vessel diameter and age. @*Results@#The median age of the subjects was 49.0 years. The mean conjunctival blood flow velocity in 53 microvessels was 0.786 ± 0.468 mm/s. The median conjunctival microvascular diameter was 7.06 μm (interquartile range 5.84 to 9.23 μm). The conjunctival microvascular diameter and blood flow velocity were not significantly correlated (Spearman’s p = 0.177), and the subjects’ age and conjunctival microvascular blood flow velocity were also not correlated (Spearman’s p = 0.669). @*Conclusions@#In this study, the blood flow velocity in the bulbar conjunctival microvessels could be measured easily by means of image analysis using a slit-lamp microscope equipped with an ultra-high-speed camera with a zoom lens.

Comparison of Meibomian Gland Loss between Demodex-infested Group and Dry Eye Patients without Demodex Infestation

Purpose@#To compare the degree of meibomian gland drop-out associated with Demodex infestation using non-contact meibography. @*Methods@#We performed noncontact meibography using an infrared digital camera on 24 adult subjects infested by Demodex and 40 without infestation. The right upper and lower lids were scored based on the loss of meibomian glands, and the scores of the upper and lower eyelids were summed to obtain the total meiboscore for each subject. Meiboscores were evaluated according to Demodex infestation and gender in each group. @*Results@#Sixty-four eyes of 64 people were enrolled in this study. The study subjects had an average age of 67.9 years (range, 40-79 years; men, 65.2 years; women, 69.1 years). There was a significant association between Demodex infestation and total meiboscore and upper and lower eyelid meiboscores (p = 0.000, p = 0.002, p = 0.004, respectively). There was no significant difference in the meiboscores between men and women. Age and meiboscore suggested a weak positive correlation; however, the R2 value was low, due to the concentrated age distribution of the study population. @*Conclusions@#Based on noncontact meibography, the authors concluded that the prevalence of changes in the meibomian glands was significantly related to Demodex infestation; however, there was no significant difference between men and women.

Comparison of Penetrating Keratoplasty and Descemet Stripping Automated Endothelial Keratoplasty in Eyes with Glaucoma Ahmed Valve implants

Purpose@#To compare the clinical outcomes of penetrating keratoplasty (PKP) and Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with Glaucoma Ahmed Valve implants. @*Methods@#The charts of 11 patients who underwent PKP and 11 who underwent DSAEK between February 2016 and June 2018 were retrospectively reviewed; all patients previously underwent Ahmed valve implant surgery. The best corrected visual acuity, intraocular pressure, and endothelial cell count were compared 1, 3, and 6 months after surgery. Graft rejection and graft failure were also evaluated during follow-up. The survival rates were compared using Kaplan–Meier survival analysis. @*Results@#The difference in graft survival rates of the PKP and DSAEK groups was not significant (p = 0.295); however, graft failure occurred earlier in the PKP group (12.9 ± 10.1 vs. 18.8 ± 5.3 months). The postoperative best corrected visual acuity of the PKP group had improved at 1 (p = 0.027) and 3 (p = 0.017) months, while the DSAEK group showed significant improvement at 1, 3, and 6 months (all p = 0.005). Intergroup analysis showed better visual prognosis of the DSAEK group at 1, 3, and 6 months after surgery (p = 0.023, p = 0.007, and p = 0.004, respectively). @*Conclusions@#In our study, the two corneal transplantation methods did not have significantly different graft survival rates; however, graft failure occured later in the DSAEK group and the postoperative visual acuity was better than in the PKP group. Although further study is needed, performing DSAEK in patients with an Ahmed valve implant seems to be a good alternative to PKP.

Repeat Descemet Membrane Endothelial Keratoplasty after Descemet Membrane Endothelial Keratoplasty Graft Failure

Purpose@#To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. @*Conclusions@#To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

Prediction of Effective Lens Position by Reference to the Preoperative Axial Length

Purpose@#We derived optimal formulae permitting effective lens position (ELP) for patients differing in terms of their preoperative axial lengths as revealed by partial coherence interferometry. @*Methods@#We included 736 eyes from 736 patients who underwent conventional cataract surgery at Yeouido St. Mary’s Hospital. The preoperative axial length (AL), corneal power (CP), and anterior chamber depth (ACD) measured via partial coherence interferometry served as independent variables for ELP prediction. The 736 eyes were divided into seven groups differing by 1.0-mm intervals in terms of the preoperative axial length. We sought correlations between the independent variables and the ELP, and defined the combinations that best predicted the ELPs of the seven groups. @*Results@#The CP correlated significantly with the ELP for eyes with AL between 22.0 and 25.0 mm (all p < 0.01) and the ACD correlated significantly with the ELP for eyes with AL between 23.0 and 26.0 mm (all p < 0.01). Although a regression equation featuring all of the AL, ACD, and CP best predicted the ELP for the total of 736 eyes (p < 0.001), the optimal combination varied by the preoperative AL. @*Conclusions@#The effects of CP, ACD, and AL on ELP vary by the preoperative AL. The optimal combination of preoperative variables predicting ELP thus varies as that parameter changes.

Descemet Membrane Endothelial Keratoplasty after Penetrating Keratoplasty Graft Failure

Purpose@#To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. @*Conclusions@#Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.

Repeat Descemet Membrane Endothelial Keratoplasty after Descemet Membrane Endothelial Keratoplasty Graft Failure

Purpose@#To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. @*Conclusions@#To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

Prediction of Effective Lens Position by Reference to the Preoperative Axial Length

Purpose@#We derived optimal formulae permitting effective lens position (ELP) for patients differing in terms of their preoperative axial lengths as revealed by partial coherence interferometry. @*Methods@#We included 736 eyes from 736 patients who underwent conventional cataract surgery at Yeouido St. Mary’s Hospital. The preoperative axial length (AL), corneal power (CP), and anterior chamber depth (ACD) measured via partial coherence interferometry served as independent variables for ELP prediction. The 736 eyes were divided into seven groups differing by 1.0-mm intervals in terms of the preoperative axial length. We sought correlations between the independent variables and the ELP, and defined the combinations that best predicted the ELPs of the seven groups. @*Results@#The CP correlated significantly with the ELP for eyes with AL between 22.0 and 25.0 mm (all p < 0.01) and the ACD correlated significantly with the ELP for eyes with AL between 23.0 and 26.0 mm (all p < 0.01). Although a regression equation featuring all of the AL, ACD, and CP best predicted the ELP for the total of 736 eyes (p < 0.001), the optimal combination varied by the preoperative AL. @*Conclusions@#The effects of CP, ACD, and AL on ELP vary by the preoperative AL. The optimal combination of preoperative variables predicting ELP thus varies as that parameter changes.

Descemet Membrane Endothelial Keratoplasty after Penetrating Keratoplasty Graft Failure

Purpose@#To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. @*Conclusions@#Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.

Echinostoma miyagawai Ishii, 1932 (Echinostomatidae) from Ducks in Aceh Province, Indonesia with Special Reference to Its Synonymy with Echinostoma robustum Yamaguti, 1935

Adult echinostomes having 37 collar spines collected from the intestine of Pitalah ducks in Aceh Province, Indonesia in 2018 were morphologically and molecularly determined to be Echinostoma miyagawai Ishii, 1932 (Digenea: Echinostomatidae). Among 20 ducks examined, 7 (35.0%) were found to be infected with this echinostome, and the number of flukes collected was 48 in total with average 6.9 (1-17) worms per duck. The adult flukes were 7.2 (6.1-8.5) mm in length and 1.2 (1.0-1.4) mm in width (pre-ovarian or testicular level) and characterized by having a head collar armed with 37 collar spines (dorsal spines arranged in 2 alternating rows), including 5 end group spines, and variable morphology of the testes, irregularly or deeply lobed (3-5 lobes) at times with horizontal extension. The eggs within the worm uterus were 93 (79-105) µm long and 62 (56-70) µm wide. These morphological features were consistent with both E. miyagawai and Echinostoma robustum, for which synonymy to each other has been raised. Sequencing of 2 mitochondrial genes, cox1 and nad1, revealed high homology with E. miyagawai (98.6-100% for cox1 and 99.0-99.8% for nad1) and also with E. robustum (99.3-99.8% for nad1) deposited in GenBank. We accepted the synonymy between the 2 species and diagnosed our flukes as E. miyagawai (syn. E. robustum) with redescription of its morphology. Further studies are required to determine the biological characteristics of E. miyagawai in Aceh Province, Indonesia, including the intermediate host and larval stage information.

Patients at High Risk for Failure of Penetrating Keratoplasty

Purpose@#We report the clinical characteristics and the primary underlying diseases of patients at high risk for failure of penetrating keratoplasty (PKP) in Korea. @*Methods@#Patients at high risk of PKP failure among those who visited the ophthalmological clinics of tertiary care hospitals in Korea from April 2019 to April 2020 and who were indicated for PKP were retrospectively enrolled. We epidemiologically investigated 119 eyes of 104 patients via medical chart review. @*Results@#Herpes simplex virus (HSV) keratitis was the most common primary underlying disease (26.1%). The most common primary cause of poor bilateral visual acuity was Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) (41.7%) followed by chemical burns (19.4%). Of the 119 eyes, 40.3% had a history of previous PKP and 20.2% had undergone three or more PKP. The average number of prior PKPs was 1.02 ± 1.46. Corneal neovascularization and corneal opacity were reported in 82.4 and 92.4% of cases, respectively. As the severity of these conditions increased, the eye distributions became larger. Of all patients, 47.9 and 31.9%, respectively, received the highest corneal neovascularization and corneal opacity scores. @*Conclusions@#Our study of patients at high risk of PKP failure improves our understanding of the relevant clinical characteristics and primary underlying diseases. Such patients require careful observation and aggressive treatment. Possible alternatives to PKP should be considered if PKP consistently fails. This study will aid clinicians in deciding whether to proceed to surgery if a poor postoperative prognosis is predictable.

Failure of Repeated MDA with Albendazole for Trichuriasis Control in Schoolchildren of the Yangon Region, Myanmar

Soil-transmitted helminth (STH) infections are still a considerable challenge in Myanmar. We undertook a control program for STH infections (especially Trichuris trichiura) among schoolchildren in Myanmar using mass drug administration (MDA) and health education. Around 1,700 schoolchildren from 15 primary schools in 3 suburban districts (Shwe Pyi Thar, Twantay, and Kyauktan) of the Yangon Region were subjected in this study during 2017-2019. All of the schoolchildren in each school were orally administered albendazole (400 mg in a single dose) 2, 3, and 4 times a year in 2017, 2018, and 2019, respectively. The results revealed that the egg positive rate of any intestinal helminths (including STH) was reduced from 37.6% (649/1,724) in 2017 to 22.8% (352/1,542) in 2019. The egg positive rate of Ascaris lumbricoides was decreased remarkably from 23.3% (402/1,724) in 2017 to 3.6% (56/1,542) in 2019. However, that of T. trichiura was only slightly reduced from 26.9% (464/1,724) in 2017 to 20.2% (312/1,542) in 2019. The intensity of infection with A. lumbricoides and T. trichiura was both more or less reduced, and the proportion of light infection cases with A. lumbricoides and T. trichiura increased from 35.6% in 2017 to 64.3% in 2019 and from 70.3% in 2017 to 81.7% in 2019, respectively. The results indicated that repeated MDAs (2-4 times a year for 3 years) using albendazole on schoolchildren in Myanmar failed to control T. trichiura infection. For a successful control of trichuriasis in Myanmar, new MDA strategies, using a modified albendazole regimen (multiple daily doses for 2 or 3 days) or an alternative anthelmintic drug, such as oxantel pamoate, is strongly recommended.

Larval Gnathostomes and Spargana in Chinese Edible Frogs, Hoplobatrachus rugulosus, from Myanmar: Potential Risk of Human Infection

Chinese edible frogs, Hoplobatrachus rugulosus, were examined to estimate the potential risks of human gnathostomiasis and sparganosis in Myanmar. A total of 20 frogs were purchased in a local market of Yangon and examined with naked eyes and the artificial digestion method after skin peeling in June 2018 and June 2019. Larvae of gnathostomes and Spirometra (=spargana) were detected in 15 (75.0%) and 15 (75.0%) frogs with average intensities of 10.5 and 6.3 larvae per infected frog, respectively. Gnathostome larvae were 2.75-3.80 (av. 3.30) mm long and 0.29-0.36 (0.33) mm wide. They had a characteristic head bulb with 4 rows of hooklets, a muscular long esophagus, and 2 pairs of cervical sac. The mean number of hooklets were 41, 44, 47, and 50 on the 1st, 2nd, 3rd, and 4th row, respectively. Collected spargana were actively moving, particularly with the scolex part, and have ivory-white color and variable in size. Conclusively, it has been first confirmed that Chinese edible frogs, H. rugulosus, are highly infected with larval gnathostomes and spargana in this study. Consuming these frogs is considered a potential risk of human gnathostomiasis and sparganosis in Myanmar.

Comparison of Optical Coherence Tomography Findings and Histological Findings of Meibomian Gland in Rats

Purpose@#To compare optical coherence tomography (OCT) and histological findings of Meibomian glands in rats. Based onthese results, the histological findings of the structures seen using OCT were clarified. @*Methods@#En bloc excision was performed on the upper and lower eyelids in two rats. The axis of the Meibomian gland was verticallyscanned with three-dimensional (3D) OCT and reconstructed into 3D images. The samples were fixed in 10% formalinagain and stained with hematoxylin and eosin. The findings of the OCT and histological examinations were then compared to determinethe histological characteristics of the structures observed in the OCT. @*Results@#The surface of the acinus was well-delineated in the Meibomian glands of rats using OCT. However, no deep acini wereobserved in the central ducts. @*Conclusions@#The structure of Meibomian glands imaged by OCT in rats was limited to the surface of the acinus. The structureof the reconstructed Meibomian gland ex vivo was similar to that of the human Meibomian gland. The possibility of developing anin vivo meibography system was therefore confirmed in animals.

Ocular Surface Staining Score and Salivary Gland Scintigraphy in Patients with Primary Sjögren’s Syndrome

Purpose@#To analyze the correlation between the ocular surface staining score and indices of salivary gland scintigraphy in patientswith primary Sjögren's syndrome and dry eye symptoms, and to evaluate the diagnostic value of these indices. @*Methods@#The patients were 51 adults with primary Sjögren's syndrome or non-Sjögren's syndrome plus dry eye symptoms, whowere referred to our ophthalmology clinic for evaluation of the degree of dry eye at the Department of Rheumatology, from July2017 to April 2019. The Mann-Whitney U test and student’s t-test were used for analyzing the ocular surface staining score andquantitative indices of salivary gland scintigraphy, respectively, in the primary Sjögren's syndrome and non-Sjögren's syndromepatients. Spearman correlation was used to analyze the correlations of ocular surface staining score with salivary scintigraphyindices. @*Results@#The ocular surface staining score (p= 0.021), parotid gland excretion fraction (p= 0.022), and submandibular gland excretionfraction (pp= 0.045) were significantly different between the primary Sjögren's syndrome and non-Sjögren's syndromepatients. The submandibular gland uptake ratio (r = -0.369, p= 0.008) and submandibular excretion fraction (r = -0.359, p=0.010) were significantly negatively correlated with ocular surface staining scores. @*Conclusions@#The ocular surface staining score was identified as the gold standard for evaluating the degree of dry eye in primarySjögren's syndrome patients. If salivary gland dysfunction is identified by salivary gland scintigraphy, ocular surface stainingshould be performed to confirm the presence of ocular surface lesions, regardless of the presence of dry eye symptoms.

Case Report of Nodular Fasciitis in the Conjunctiva

PURPOSE: We report a case of nodular fasciitis of the conjunctiva that has not been previously reported in the Republic of Korea.CASE SUMMARY: A 18-year-old female patient presented with a left conjunctival mass, which had been enlarging for 1 month. The tumor was located at the corner of the conjunctiva of the left eye. The size of the tumor was 1 mm in width and 1.5 mm in height, and tenderness and redness were not observed. There was no history of trauma, but bilateral upper lid blepharoplasty was performed 2 months prior to her visit. Excision of a conjunctival mass was performed and there was no evidence of involvement of the sclera or peripheral conjunctiva around the mass. We performed immunohistochemistry and PCR for human herpes virus 8 (HHV8). Immunohistochemistry was positive for S-100 and negative for smooth muscle actin and HHV8. The mass was myofibroblastic in nature and the histopathological features and clinical findings of this case were diagnosed as nodular fasciitis with the features as described above. There was no recurrence for 4 months after removal of the mass.CONCLUSIONS: Because the treatments and prognoses of malignant tumors or other inflammatory diseases such as nodular scleritis and nodular fasciitis are quite different, differentiation from these diseases is considered an important factor in the diagnosis of nodular fasciitis.

Comparison of the Long-term Clinical Outcomes of Penetrating Keratoplasty Using a Manual Trephine and Femtosecond-Laser Trephination

Purpose@#We compare the clinical outcomes of femtosecond-laser penetrating keratoplasty and penetrating keratoplasty performed using a manual trephine. @*Methods@#The clinical outcomes of 21 eyes that underwent penetrating keratoplasty using a manual trephine and 29 eyes that underwent femtosecond-laser penetrating keratoplasty were compared in terms of best-corrected visual acuity, refractive and corneal astigmatisms, endothelial cell counts, and graft rejection and failure. @*Results@#The best-corrected visual acuities measured 1, 3, 6, 12, and 18 months after surgery were logMAR 1.21, 1.28, 1.25, 1.14, and 1.43 for the manual trephine group and logMAR 0.82, 0.71, 0.78, 0.49, and 0.56 for the femtosecond-laser group; the latter group thus exhibited better visual acuity at all times. The refractive astigmatism values were 5.13, 6.35, 5.28, 5.18, and 6.36 diopters (D) for the manual trephine group and 6.09, 6.33, 5.14, 5.23, and 4.89 D for the femtosecond-laser group. The corneal astigmatism values were 5.40, 6.45, 6.30, 5.64, and 5.78 D for the manual trephine group and 6.17, 6.24, 5.72, 5.02, and 4.83 D for the femtosecond-laser group. The refractive astigmatism was significantly lower at 18 months after surgery and the corneal astigmatism was significantly lower at both 12 and 18 months after surgery in the femtosecond-laser group. None of endothelial cell count, graft rejection or failure rate, differed significantly between the two groups. @*Conclusions@#Femtosecond-laser-enabled keratoplasty affords better visual recovery, less refractive and corneal astigmatism, and better wound stability than does penetrating keratoplasty using a manual trephine.

Descemet Membrane Endothelial Keratoplasty to Treat Graft Failure after Descemet Stripping Endothelial Keratoplasty

Purpose@#We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. @*Conclusions@#Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

Comparison of the Long-term Clinical Outcomes of Penetrating Keratoplasty Using a Manual Trephine and Femtosecond-Laser Trephination

Purpose@#We compare the clinical outcomes of femtosecond-laser penetrating keratoplasty and penetrating keratoplasty performed using a manual trephine. @*Methods@#The clinical outcomes of 21 eyes that underwent penetrating keratoplasty using a manual trephine and 29 eyes that underwent femtosecond-laser penetrating keratoplasty were compared in terms of best-corrected visual acuity, refractive and corneal astigmatisms, endothelial cell counts, and graft rejection and failure. @*Results@#The best-corrected visual acuities measured 1, 3, 6, 12, and 18 months after surgery were logMAR 1.21, 1.28, 1.25, 1.14, and 1.43 for the manual trephine group and logMAR 0.82, 0.71, 0.78, 0.49, and 0.56 for the femtosecond-laser group; the latter group thus exhibited better visual acuity at all times. The refractive astigmatism values were 5.13, 6.35, 5.28, 5.18, and 6.36 diopters (D) for the manual trephine group and 6.09, 6.33, 5.14, 5.23, and 4.89 D for the femtosecond-laser group. The corneal astigmatism values were 5.40, 6.45, 6.30, 5.64, and 5.78 D for the manual trephine group and 6.17, 6.24, 5.72, 5.02, and 4.83 D for the femtosecond-laser group. The refractive astigmatism was significantly lower at 18 months after surgery and the corneal astigmatism was significantly lower at both 12 and 18 months after surgery in the femtosecond-laser group. None of endothelial cell count, graft rejection or failure rate, differed significantly between the two groups. @*Conclusions@#Femtosecond-laser-enabled keratoplasty affords better visual recovery, less refractive and corneal astigmatism, and better wound stability than does penetrating keratoplasty using a manual trephine.