Background: DALK is agolden method for treatment of keratoconus with preservation of endothelium. femtosecond laser-assisted DALK (F-DALK) is a new technique used nowadays to overcome difficulties of an old one. Aims: To contrast the results of manual deep anterior lamellar keratoplasty (M-DALK) with (F-DALK) in keratoconus studied cases. Subjects and methods: This prospective interventional research was carried out between January 2021 and December 2022. 36 eyes of 36 studied cases with advanced keratectasia were enrolled in this research and all underwent either manual (17 patients) or (F-DALK) (19 patients) at Tiba Eye Center, Assiut, Egypt. They were done by single surgeon.
Results: There was significant improvement in visual acuity at one month, 3 months, six months and 1 year post-operatively in 2 groups. Postoperatively, healing had been more evident post-operatively after the 6^th month than after 1^st and 3^rd month. Side cut healing was more evident in the(F- DALK) patients than manual DALK studied cases with a statistically significant difference among the 2 groups (𝑃 0.02). 12 eyes (63.2%) and 4 eyes (23.5 %) of F-DALK and M- DALK cases presented wound healing patterns Grade 4 respectively.  Conclusion: Comparable visual and refractive results are obtained with both techniques; however, corneal wound healing patterns at the side cut were more noticeable with femtosecond assisted DALK. This observation suggests that, when femtosecond technology has been utilized to conduct the side cut for DALK, an active cornea wound healing may allow earlier suture removal.