Irregularity of the Posterior Corneal Surface After Curved Interface Femtosecond Laser-Assisted Versus Microkeratome-Assisted Descemet Stripping Automated Endothelial Keratoplasty

Abstract

Our study underlines the current superiority of a microkeratome-assisted preparation of the stromal-endothelial lamella before DSAEK surgery compared with the curved interface femtosecond laser-assisted processing.

Effects of corneal irregular astigmatism on visual acuity after conventional and femtosecond laser-assisted Descemet’s stripping automated endothelial keratoplasty

“…However, in two studies the mean visual acuity after f-DSAEK is reported to be 20/87 [1] and 20/94 [22] at 6 months: lower than conventional PK. Vetter et al report that the mean visual acuity after f-DSAEK was 0.48 log-MAR and significantly worse than after m-DSAEK [27]. A report by Rosa et al is unique in that DSAEK grafts were prepared using both an fs-laser and a microkeratome, and the postoperative visual acuity was excellent (0.11 log-MAR) at 6 months [26].…”

“…The irregular astigmatism after f-DSAEK results in poor visual outcome. It is documented that the fslaser is safe and effective for DSAEK [1,21,[25][26][27], but previous reports of f-DSAEK suggest that visual outcomes are inferior to m-DSAEK. Visual acuity after conventional m-DSAEK generally improves to 20/30 or better [28,29].…”

Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria)

“…12,25 Perhaps suboptimal laser settings resulted in the poorer visual outcomes observed with EK prepared with the Visumax (200 kHz) than with Amadeus II microkeratome (Ziemer Ophthalmic Systems AG, Port, Switzerland). 28 Scanning electron microscopy (SEM) images have been used several times to assess the smoothness of lamellar cuts. Initially, subjective grading of roughness by one or more observers was utilized, however it has been shown that this grading is susceptible to variations in contrast.…”

Femtosecond laser in corneal surgery

“…Более низкая острота зрения после использования фемтосекундного лазера предположительно может быть ассоциирована с наличием так называемого «хейза» в области интерфейса «донор-реципиент», представляющего собой пролиферативный ответ кератоцитов на их активацию энергетическим воздействием. Также на функциональные результаты могла повлиять нерегулярность поверхности эндотелия, связанная в первую очередь с аппланационной нагрузкой и компрессией роговицы при проведении лазерного этапа [96].…”

“…Современные хирургические возможности коррекции пресбиопии включают вмешательства на хрусталике и роговице [3,53,96]. Концепция интракорнеальных линз, так называемых роговичных инлаев, существует с конца 1940-х гг.…”