Applications of the femtosecond laser in corneal refractive surgery

Kim, Peter; Sutton, Gerard; Rootman, David S.

doi:10.1097/icu.0b013e3283477c9c

Cited by 85 publications

(43 citation statements)

References 55 publications

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“…[13][14][15][16][17][18][19][20][21][22] The therapeutic results of femtosecond laser-assisted incisions that penetrate the epithelium are similar compared to the mechanical incisions. [14][15][16][17][18][19][20] We studied the effect of intrastromal relaxing incisions made with a femtosecond laser.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Postoperative Keratoplasty Astigmatism Using Femtosecond Laser-Assisted Intrastromal Relaxing Incisions

Wetterstrand¹,

Holopainen²,

Krootila³

2013

J Refract Surg

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PURPOSE: To investigate the effectiveness of femtosecond laser-assisted intrastromal relaxing incisions for astigmatism management and establish laser treatment parameters. METHODS:Sixteen eyes of 16 patients had regular astigmatism after penetrating keratoplasty. All sutures had been removed and the refraction was stabilized. Paired arcuate intrastromal incisions were made 180° apart within the graft stroma with a femtosecond laser preserving the epithelium. Follow-up examinations were performed at 1 week, 2 weeks, 1 month, and 3 months. RESULTS:The logMAR corrected distance visual acuity (CDVA) improved from 0.50 ± 0.29 to 0.32 ± 0.23 (Snellen 20/63 to 20/40). Refractive and topographic anterior cylinders decreased from 6.8 ± 2.2 diopters (D) to 3.7 ± 1.7 D and from 9.5 ± 4.8 D to 4.4 ± 2.1 D, respectively. Stabilization of topographic cylinder was observed 1 month postoperatively. The worse the preoperative CDVA was and the higher the preoperative values for the refractive and topographic cylinders were, the higher the surgically induced changes were. Anterior side cut angles at 90° and 120° produced similar results. A bulge of incision occurred in one eye requiring compression sutures.CONCLUSIONS: Signifi cant improvement in CDVA and refractive and topographic cylinders indicated a good effect of femtosecond laser-assisted intrastromal relaxing incisions in reducing astigmatism. No advantage between 90° and 120° anterior side cut angles was found. No infections were recorded and no patient expressed discomfort.[J Refract Surg. 2013;29(6):378-382.] stigmatism occurring after penetrating keratoplasty is common and 4 to 5 diopters (D) of postoperative penetrating keratoplasty astigmatism is not unusual.1 Mild cases can be treated with spectacles or contact lenses. However, some patients with postoperative penetrating keratoplasty have more severe astigmatism that requires surgical treatment.2,3 Arcuate keratotomy is a surgical method to treat astigmatism and is traditionally made mechanically with a knife or keratome. [4][5][6][7][8][9][10][11][12] This causes the incised meridian to fl atten and steepen perpendicularly, thus reducing astigmatism. 13 The advantages of arcuate keratotomy are that it does not penetrate the anterior chamber, it preserves the optic axis, and it can be used to treat high astigmatism.The use of femtosecond lasers for relaxing incisions has been studied. [13][14][15][16][17][18][19][20][21][22] The therapeutic results of femtosecond laser-assisted incisions that penetrate the epithelium are similar compared to the mechanical incisions. [14][15][16][17][18][19][20] We studied the effect of intrastromal relaxing incisions made with a femtosecond laser. Theoretical advantages of intrastromal incisions where the corneal surface is not penetrated are a reduced risk for infection and reduced inconvenience caused by pain. PATIENTS AND METHODSAll patients were referred to Helsinki University Eye Hospital for treatment of postoperative penetrating keratoplasty astigmatism. They wer...

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Section: Resultsmentioning

confidence: 99%

Treatment of Postoperative Keratoplasty Astigmatism Using Femtosecond Laser-Assisted Intrastromal Relaxing Incisions

Wetterstrand¹,

Holopainen²,

Krootila³

2013

J Refract Surg

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“…While refractive surgery is becoming more affordable and safe, it may not be recommended for everybody. Patients that have medical conditions such as glaucoma, diabetes uncontrolled cardiovascular disease, autoimmune disease, pregnant women or people with certain eye disease are not good candidates for refractive surgery (Kim et al, 2011). Although the risk of complications is decreasing compared to the early days of refractive surgery, there is still a small chance for serious problems.…”

Section: Application Of Lasers In Ophthalmologymentioning

confidence: 99%

“…Lasers are also used in medical operations in the field of refractive eye surgery (Gilmour, 2002;Glinkowski & Pokora, 1993;Kim et al, 2011). The main aim of that kind of treatment is to achieve the correct relationship between the length of the eyeball and the power of its optical centers.…”

Section: Application Of Lasers In Ophthalmologymentioning

confidence: 99%

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Lasers in Ophthalmology

Zdybel¹,

Pilawa²,

Krzeszewska-Zaręba³

2012

Advances in Ophthalmology

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“…Ever since they were first introduced for corneal flap creation [1,2] in Laser-Assisted in situ Keratomileusis (LASIK), ultrafast lasers have become a standard resource in corneal refractive surgery [3] and an emerging tool for use in cataract surgery [4]. Extensive research aims to incorporate ultrafast lasers in various surgical procedures such as microsurgery of vocal folds [5], craniofacial osteotomy [6], stapedotomy [7], cardiology [8,9], dentistry [10,11], and sub-cellular nanosurgery [12,13].…”

Section: Introductionmentioning

confidence: 99%

Pulsetrain-burst mode, ultrafast-laser interactions with 3D viable cell cultures as a model for soft biological tissues

Qian¹,

Mordovanakis²,

Schoenly³

et al. 2013

Biomed. Opt. Express

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A 3D living-cell culture in hydrogel has been developed as a standardized low-tensile-strength tissue proxy for study of ultrafast, pulsetrain-burst laser-tissue interactions. The hydrogel is permeable to fluorescent biomarkers and optically transparent, allowing viable and necrotic cells to be imaged in 3D by confocal microscopy. Good cellviability allowed us to distinguish between typical cell mortality and delayed subcellular tissue damage (e.g., apoptosis and DNA repair complex formation), caused by laser irradiation. The range of necrosis depended on laser intensity, but not on pulsetrain-burst duration. DNA double-strand breaks were quantified, giving a preliminary upper limit for genetic damage following laser treatment. . 103(2), 577-644 (2003).

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Applications of the femtosecond laser in corneal refractive surgery

Abstract: This review outlines the recent advances and applications of the femtosecond laser in corneal refractive surgery.

Cited by 85 publications

References 55 publications

Treatment of Postoperative Keratoplasty Astigmatism Using Femtosecond Laser-Assisted Intrastromal Relaxing Incisions

Treatment of Postoperative Keratoplasty Astigmatism Using Femtosecond Laser-Assisted Intrastromal Relaxing Incisions

Lasers in Ophthalmology

Pulsetrain-burst mode, ultrafast-laser interactions with 3D viable cell cultures as a model for soft biological tissues

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