Comparison of Long-Term Outcomes of Femtosecond Laser-Assisted Keratoplasty with Conventional Keratoplasty

Daniel, Moritz Claudius; Böhringer, Daniel; Maier, Philip; Eberwein, Philipp; Birnbaum, Florian; Reinhard, Thomas

doi:10.1097/ico.0000000000000739

Cited by 35 publications

(31 citation statements)

References 25 publications

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“…In the present study, we did not find a significant difference in ECD or graft thickness between EXCIMER and FEMTO trephinations, either with all-sutures-in or all-sutures-out. Both trephination procedures using the laser beam seem to be safe for the central corneal endothelium and had no disadvantages regarding ECL compared to mechanical trephination after PK in earlier studies [10][11][12]. However, EXCIMER and FEMTO trephination may lead to different changes of the blood-aqueous barrier [21,22], to elevation of prostaglandin [23] and free radical levels in the anterior chamber [24], which may also influence ECD in a different way in the longer term after PK [25].…”

Section: Discussionmentioning

confidence: 99%

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Endothelial cell density and corneal graft thickness following excimer laser vs. femtosecond laser-assisted penetrating keratoplasty—a prospective randomized study

Tóth

Butskhrikidze

Seitz

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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Purpose The study aims to compare the impact of non-mechanical excimer laser-assisted (EXCIMER) and femtosecond laserassisted (FEMTO) trephinations on graft endothelial cell density (ECD) and graft thickness before and after suture removal following penetrating keratoplasty (PK). Methods The inclusion criteria for this prospective, randomized, clinical study were as follows: (1) surgeries performed by one surgeon; (2) primary central PK; (3) keratoconus (KC) or Fuchs' dystrophy (FUCHS); (4) no previous intraocular surgery; (5) graft oversize, 0.1 mm; and (6) 16-bite double-running suture. In 68 eyes of 68 patients (mean age: 53.3 ± 19.8 years), PK was performed using either 193-nm MEL70 excimer laser (BEXCIMER^: 17 KC, 18 FUCHS) or 60-KHz femtosecond laser (BFEMTO^: 17 KC, 16 FUCHS) trephination. Specular microscopy (EM 3000) and pachymetry (EM 3000; Pentacam HR; Casia SS-1000) were performed before removing the first suture (11.4 ± 1.9 months) and after removing the second suture (22.6 ± 3.8 months), but before any additional ophthalmic surgery. Results ECD did not differ significantly (P ≥ 0.436) between EXCIMER and FEMTO either with Ball-sutures-in^(1887 ± 409 vs. 1886 ± 438) or with Ball-sutures-out^(1703 ± 379 vs. 1737 ± 362). Central corneal thickness and corneal thickness at the thinnest point of the cornea did not differ significantly between EXCIMER and FEMTO either with all-sutures-in (P ≥ 0.096 and P ≥ 0.653) or with all-sutures-out (P ≥ 0.636 and P ≥ 0.717). Conclusions EXCIMER and FEMTO trephinations from the epithelial side seem to have no disadvantages regarding endothelial cell loss after PK, and both surgical procedures are safe for the endothelium. A larger sample size and longer follow-up are needed to evaluate the long-term impact of EXCIMER and FEMTO trephinations on ECD.

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Section: Discussionmentioning

confidence: 99%

“…Earlier studies comparing ECL after EXCIMER and mechanical trephinations, as well as FEMTO and mechanical trephinations, have shown that EXCIMER and FEMTO have no adverse effects on the graft endothelium compared to mechanical trephination, respectively [9][10][11][12].…”

Section: Introductionmentioning

confidence: 97%

Endothelial cell density and corneal graft thickness following excimer laser vs. femtosecond laser-assisted penetrating keratoplasty—a prospective randomized study

Tóth

Butskhrikidze

Seitz

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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“…They found that the greatest difference in astigmatism was observed at month 1, followed by month 3, when the average astigmatism was 4.5 D in the conventional group vs 3.0 D in the FSL group. On the other hand, Daniel et al [ 53 ] found no significant difference in the refractive and visual outcomes after FSL-assisted PK compared with the guided trephine system keratoplasty. Most authors agree that FSL-assisted PK enables faster and more stable wound healing, allowing earlier complete suture removal than conventional PK.…”

Section: Current Treatment Options and Managementmentioning

confidence: 99%

Keratoconus Treatment Algorithm

et al. 2017

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Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.

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“…A látóélesség viszonylag gyorsan javult FLAK után, mind saját, mind más szerzők eredményei szerint. A legjobban korrigált látás egységesen 0,6 volt, azon szerzők közlése szerint, akik legalább 10 műtét eredményét vették figyelembe, és legalább egy évig követték a pácienseket [19][20][21][22][23]. A funkcionális kimenetelt a kísérő szemészeti betegségek is befolyásolták, mint saját eseteinkben is.…”

Section: áBraunclassified

“…Az anatómiai paraméterek is kedvezően alakultak műtét után. A cornealis astigmia a fenti szempontok alapján (legalább 10 beteg, egyéves követés, varratszedés utáni állapot) 6,0 D körül alakult három tanulmányban, egyben 2,84 D, egyben pedig 3,6 D volt [19][20][21][22][23]. Ezekben az esetekben a lézerkészülék különbözött az általunk használttól, és a donor, valamint a recipiens trepanálásakor különböző konfigurációkat használtak (cikcakk-, gomba-és cilinderalakzatot).…”

Section: áBraunclassified