To describe a case of a 52-year-old man with severe keratoconus who underwent femtosecond laser-assisted keratoplasty with the WaveLight FS200 femtosecond laser (Alcon Laboratories Inc). The donor and recipient corneas were cut in a mushroom-shaped pattern. The laser parameters used on this platform for the donor and recipient corneas are described. Corrected distance visual acuity improved by 3 weeks postoperatively. Mean keratometry decreased from 60.00 to 46.00 diopters. This patient underwent a mushroom-shaped keratoplasty with the femtosecond laser to maximize preservation of his own endothelium. Increased energy and/or decreased spot line separation may be required depending on the degree of corneal edema or scarring involved.
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