Femtosecond laser-assisted keratoplasty: a case series

Session Details

Session Title: Refractive Corneal Surgery

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 08:47

Venue: Boulevard A

First Author: : H.Sitnik BELARUS

Co Author(s): :                  

Abstract Details

Purpose:

To evaluate the initial results of femtosecond laser-assisted keratolpasty

Setting:

Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus

Methods:

A prospective study of 43 consecutive patients (45 eyes) was performed (26 men, 17 women, mean age 32.4±7.8 years). The follow-up period varied from 5 month to 18 month. A detailed ophthalmological examination, including anterior OCT, endothelial cell count, corneal topography, pachymetry before and after surgical procedure was done. Advanced keratoconus was diagnosed in 37 eyes, corneal dystrophy – in 4 eyes, central opacity – 2 eyes, secondary corneal ectasia – 2 eyes. All patients underwent a surgical treatment (femtosecond laser-assisted DALK – 10, femtosecond laser-assisted PKP – 35 eyes). Femtosecond laser mushroom configuration of donor cornea with matched dimensions on the recipient cornea was used in 40 eyes, straight-edge configuration was performed in 5 eyes. Tissue bridge (70 µm) were cut by scissors for completion of trephination on an recipient’s eye in all cases of PKP. “Big bubble” technique was used in all cases of FS DALK.

Results:

BCVA of patients with no ocular comorbidity ranged from 20/20 to 20/60. At 4 months after the surgery there was no significant difference between mean BCVA between the two groups. Mean cylindrical refractive error at last visit was 2.56 D (from 0.50 to 4.00D) in both groups. At 1-3 months post-op OCT scanning showed better graft-host alignment after FS DALK. Endothelial cells density was 2463,33 ± 208,39 c/mm (from 2100 to 2600) in eyes after FS DALK, 1737,6 ± 587,7 c/mm (from 890 to 2400) after FS PKP at last visit. Rates of intraoperative and postoperative complications were low. Intraoperative Descemet’s membrane (DM) perforations which did not require conversion of DALK to penetrating keratoplasty were observed in 2 cases, postoperative DM detachment in 1 case. Delayed epithelial healing and increased intraocular pressure which resolved with topical anti-glaucoma drops were observed in 3 eyes. Stromal rejection was diagnosed in 1 case after FS PKP.

Conclusions:

Femtosecond laser-assisted PKP and DALK provided a good visual outcome and early visual rehabilitation due to precise graft-host alignment. The need of suture fixation of donor corneal transplant leaves the problem of astigmatism. The optimal terms of suture removal after mushroom FS DALK and mushroom FS PKP should be determine individually. Higher endothelial cells density was observed after FS DALK.

Financial Interest:

NONE