Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty Outcomes and Healing Patterns Compared to Manual Technique

Abstract

The purpose of the study is to report the visual, refractive, and wound healing pattern outcomes of femtosecond assisted deep anterior lamellar keratoplasty (DALK) compared to the conventional manual technique. DALK was performed on 50 eyes of 47 advanced keratoconus patients. The patients were divided into two groups, 25 eyes each, depending on whether femtosecond assisted or manual DALK technique was performed for the side cut of the procedure only. Patients were followed up at 1 month, 6 months, and 1 year for visual acuity, clinical refraction, corneal cylinder, date of suture removal, and side cut corneal healing pattern according to new grading classification of the side cut scar (Grade 0 = transparent scar, 1 = faint healing opacity, 2 = evident healing opacity, 3 = significant opacity with some cosmetic imbalance, and 4 = highly significant opacity with very significant cosmetic imbalance). Outcomes are reported at one year. In conclusion, femtosecond assisted and manual DALK show comparable visual and refractive outcomes but femtosecond assisted DALK shows more evident corneal wound healing patterns at the side cut. This observation may indicate that an activated cornea wound healing might allow earlier suture removal when femtosecond technology is used to perform the side cut for DALK.

Deep anterior lamellar keratoplasty: A surgeon's guide

“…Injection of air at this precisely predefined pre-Descemet plane facilitates the big bubble formation with full baring of DM and a smaller diameter area in which the bubble or manual dissection needs to be created. 37 , 38 , 76 , 77 In addition to its advantage in facilitating the DALK procedure, using the femtosecond laser to create corneal shaped wound configurations offers the advantages of better donor–recipient fit with increased surface area contact, resulting in faster wound healing that promotes earlier suture removal and reduced astigmatism. 78 , 79 Thus, some authors 80 feel that performing femtosecond laser assisted DALK is technically easier and more successful than manual DALK.…”

“… 29 In the literature, DALK has been broadly classified as pre-Descemetic, where a small amount of posterior stroma is left intact along with the DM, and Descemetic DALK where the dissection is achieved up to the DM. 11 Several techniques have been employed to achieved these dissections including big bubble technique, 8 , 30 intrastromal air injection, 31 , 32 Melles technique, 33 , 34 hydrodelamination, 12 viscodissection, 35 , 36 femtosecond laser assisted, 37 , 38 etc.…”

Advances in femtosecond laser technology

“…FS assisted and manual techniques show comparable visual and refractive outcomes at 1 year after the surgery. 65 …”

Transplante de córnea no Brasil: progresso e dificuldades em 16 anos

“…Com o desenvolvimento de fios e agulhas finos, materiais cirúrgicos precisos, microscópio cirúrgico com boa definição de imagem, solução de preservação da córnea mais eficiente, imunossupressores modernos, conhecimento da função endotelial, o surgimento do laser de femtossegundo e o aprimoramento de técnicas lamelares, o TC tem proporcionado bons resultados visuais [11][12][13][14] . O TC pode ser assistido por laser de femtossegundo, que proporciona uma menor taxa de complicação e facilita o controle do astigmatismo pós-operatório [15][16][17][18] . que impulsiona os pacientes a submeterem-se a cirurgia 12,13,27,28 .…”

“…No Brasil, existem três fontes de dados sobre TCs e BTOs. Porém, há uma escassez na literatura nacional 30,[32][33][34][35][36][37][38][39] [15][16][17][18]64 .…”