Efficacy and Safety of Femtosecond Laser-Assisted Corneal Endothelial Keratoplasty: A Randomized Multicenter Clinical Trial

Abstract

FLEK effectively reduces postoperative astigmatism and results in an absence of wound healing related problems in patients with endothelial disease. However, visual acuity is lower as compared with conventional PK, and the high level of endothelial cell loss warrants a modification of the insertion technique of the endothelial graft.

Determinants of visual quality after endothelial keratoplasty

“…25,86 This was attributed to interface haze and increased stray light, potentially caused by laser-activation of keratocytes, as well as irregularity of the laserdissected graft surface. 25 Refinements in graft preparation (manual and automated microkeratome techniques) and progressively thinner lenticules may reduce the role of interface irregularities in determining postoperative visual outcomes.…”

Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy

“…We also included one study that had compared femtosecond laser-assisted endothelial keratoplasty (FLEK) versus PKP. ) was found to be significantly less following EK than PKP, and the endothelial cell counts were significantly lower with EK procedures in another trial (Cheng 2009). In terms of adverse outcomes, Cheng 2009 reported that graft dislocation, acute IOP elevation, primary graft failure and endothelial cell loss were more common in the EK group, whereas wound and suture-related problems were more common in the PKP group.…”

“…Detailed characteristics of the included studies are presented in the 'Characteristics of included studies' Cheng 2009 and in an attempt to obtain outcome data for FED eyes alone but they were unable to provide these data. Given the paucity of studies in this area and considering the fact that FED accounted for the majority of the results we included these trials in this review.…”

“…Techniques such as deep lamellar endothelial keratoplasty (DLEK), with a large incision, are not performed routinely and they have been superseded by other techniques with smaller incisions. However, the only RCTs that met our inclusion criteria employed DLEK (McLaren 2009; or femtosecond laser-assisted endothelial keratoplasty (FLEK) (Cheng 2009). The commonest EK procedure currently performed is Descemet's stripping automated endothelial keratoplasty (DSAEK) or Descemet's stripping endothelial keratoplasty (DSEK) rather than DLEK.…”

“…In terms of outcomes specification, the completeness of outcome data were not satisfactory. For the primary outcome, where we intended to evaluate BCVA at 24 months, only two out of the three studies (Cheng 2009;) had followup at one year. In terms of disease or condition, although we intended to assess patients with FED only, two out of the three studies (Cheng 2009;) had a small portion of patients with other conditions; however, as most patients had FED, we still decided to include these studies to provide a broader view of this research field to readers.…”