Application of Femtosecond Laser in Anterior Segment Surgery

Han, Sang Beom; Liu, Yu-Chi; Mohamed-Noriega, Karim

doi:10.1155/2020/8263408

Cited by 23 publications

(31 citation statements)

References 125 publications

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“…2 Despite the high rates of success, corneal transplantation is still complicated by relevant risks of intraoperative drawback, graft failure, and immunological complications. 3 For these reasons, in recent years, taking advantage of femtosecond laser (FSL) technology that allows precise and reproducible corneal cuts, 4 there has been a growing interest in stromal lenticule addition keratoplasty (SLAK) for the surgical treatment of advanced KC. The SLAK is a sutureless kind of keratoplasty which resumes the stromal keratophakia technique invented by Prof. Barraquer in 1960 and consists of the insertion of a lamella of the donor cornea inside a pocket sculpted into the host's stroma.…”

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confidence: 99%

Meniscus-Shaped Stromal Lenticule Addition Keratoplasty for Corneal Regularization and Thickening in Advanced Keratoconus

Pedrotti

Bonacci

Fasolo

et al. 2022

Cornea

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The aim of this study was to investigate the outcome of the meniscus-shaped stromal lenticule addition keratoplasty (MS-SLAK) in corneal regularization and thickness.Methods: Patients waiting for deep anterior lamellar keratoplasty for advanced keratoconus with an intolerance to contact lenses (CLs) underwent the MS-SLAK procedure by FSL 80 kHz ablation (VICTUS, Technolas Perfect Vision, DE). Customized positive meniscus-shaped stromal lenticules were obtained and implanted. Examination was performed at baseline and at 3-, 6-, and 12-month follow-up and included corrected distance visual acuity both with spectacles and CLs (spectacle CDVA and CL-CDVA), manifest refraction spherical equivalent, slit-lamp examination, anterior segment optical coherence tomography, corneal topography, and in vivo confocal microscopy.Results: Fifteen patients completed the study. Statistical increases in corneal thickness values were found from the first follow-up (P , 0.001). Improvement in the Surface Asymmetry Index (P = 0.04), Symmetry Index (P = 0.02), spherical aberration (P , 0.001), coma (P= 0.18), high-order aberration (P = 0.37), and anterior asphericity index (Q) (P = 0.31) were found at 12 months. At the 12-month follow-up, no improvement were found in spectacle CDVA (P = 0.23); however, all patients reported CL wearing tolerance recovery, and significant improvement in CL-CDVA (P = 0.002) was found. The confocal microscopy at 12 months showed a significant increase in keratocyte density within the lenticule and absence of fibrotic reactions in both anterior and posterior interfaces.Conclusions: MS-SLAK seems to be effective in regularizing the corneal surface as showed by the significant improvement in topographic symmetry indices, coma, and high-order aberration. The corneal regularization is also confirmed by the results in anterior Q and the recovery of the CL wearing tolerance.

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confidence: 99%

Meniscus-Shaped Stromal Lenticule Addition Keratoplasty for Corneal Regularization and Thickening in Advanced Keratoconus

Pedrotti

Bonacci

Fasolo

et al. 2022

Cornea

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“…In reviewing the literature, we found that the use of the FLACS technique entails a learning curve [ 26 ]. Several studies have indicated increased safety after a learning curve [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting

Riemey¹,

Latz²,

Mirshahi³

2022

PLoS ONE

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In this study, we report data on intraoperative complications occurring after cataract surgery in a high-volume single-center setting using a low-energy, mobile femtosecond laser. We retrospectively reviewed the medical records of patients who underwent femtosecond laser-assisted cataract surgery (FLACS) in our hospital between August 2015 and December 2019. Among the sample of 1,806 eyes of 1,131 patients (903 left and 903 right eyes), the mean age was 75.8 years (range, 21–99 years). The overall intraoperative complication rate was 0.28% (n = 5), with three cases of anterior capsule tear (0.17%) and two cases of posterior capsule tear (0.11%). No further complications occurred. This study underlines the safety of low-energy femtosecond-assisted cataract surgery in a real-world setting with a very low rate of intraoperative complications.

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“…The femtosecond laser is a neodymium glass laser employing ultrashort pulse durations that allows making corneal incisions at the desired depth. [ 62 ] Several previous studies have described the use of the femtosecond laser during DALK to create lamellar side cuts[ 63 64 65 66 ] and an intrastromal channel for the air injection. [ 67 68 69 ] To date, the additional costs associated with this technology do not seem justified by the gains in patient outcomes.…”

Section: K Ey I Ssues M ...mentioning

confidence: 99%

Deep anterior lamellar keratoplasty for keratoconus

Pellegrini

Busin

2022

Saudi Journal of Ophthalmology

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Advanced keratoconus may require keratoplasty when the patient can no longer achieve functional vision with glasses and contact lenses. Deep anterior lamellar keratoplasty (DALK) has become the surgical treatment of choice due to its undisputed advantages over penetrating keratoplasty including the reduced risk of intraoperative complications, the absence of endothelial immune rejection, and the longer graft survival. Albeit “big-bubble” DALK still represents the most popular surgical method, several modifications have been developed over the years. This allowed standardization of the technique, with improved success rates and clinical outcomes. This review presents an overview on the literature on DALK surgery for keratoconus. We discuss state-of-the art surgical techniques, current evidence on the clinical outcomes and complications as well as possible future directions.

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Application of Femtosecond Laser in Anterior Segment Surgery

Cited by 23 publications

References 125 publications

Meniscus-Shaped Stromal Lenticule Addition Keratoplasty for Corneal Regularization and Thickening in Advanced Keratoconus

Meniscus-Shaped Stromal Lenticule Addition Keratoplasty for Corneal Regularization and Thickening in Advanced Keratoconus

Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting

Deep anterior lamellar keratoplasty for keratoconus

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