Systematic review and meta-analysis of femtosecond laser–enabled keratoplasty versus conventional penetrating keratoplasty

2020 ◽  
pp. 112067212091448
Author(s):  
Yang Liu ◽  
Xiaojun Li ◽  
Wenjie Li ◽  
Xudong Jiu ◽  
Mannan Tian
Keyword(s):  
Femtosecond Laser ◽  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Mean Difference ◽  
Spherical Equivalent ◽  
Corrected Visual Acuity ◽  
Standard Mean Difference ◽  
Topographic Astigmatism ◽  
Best Corrected Visual Acuity

Purpose: The aim of this meta-analysis is to compare femtosecond laser–enabled keratoplasty with conventional penetrating keratoplasty regarding postoperative astigmatism, visual functions, graft rejection, graft failure, and complications. Methods: Eligible studies were retrieved from five mainstream electronic databases, including PubMed, Embase, Ovid MEDLINE, Cochrane Library, and ClinicalTrial.gov. Postoperative topographic astigmatism was set as the primary outcome, and best-corrected visual acuity, spherical equivalent, endothelial cell density, graft rejection, graft failure, and complications were chosen as the secondary outcomes. Standard mean difference and risk ratio were the size effects for continuous data and binomial data, respectively. The data were pooled through either the random-effects model or the fixed-effects model based on data heterogeneity. Moreover, subgroup analyses were conducted when the heterogeneity occurred distinctly (I2 > 50%). Results: A total of seven comparative studies were included. The pooled standard mean difference (−0.32, 95% confidence interval: −0.74 to 0.10) showed that femtosecond laser–enabled keratoplasty was not superior over conventional penetrating keratoplasty to decrease postoperative topographic astigmatism (p = 0.14). However, best-corrected visual acuity after femtosecond laser–enabled keratoplasty was significantly better than that after conventional penetrating keratoplasty (p = 0.00, standard mean difference: −0.23, 95% confidence interval: −0.37 to −0.10). Furthermore, endothelial cell density after femtosecond laser–enabled keratoplasty was preserved significantly better (p = 0.03, standard mean difference: 0.63, 95% confidence interval: 0.07–1.20). Moreover, spherical equivalent, graft rejection, graft failure, and complications represented no distinct differences between femtosecond laser–enabled keratoplasty and conventional penetrating keratoplasty (p > 0.05). Conclusion: Femtosecond laser–enabled keratoplasty may not be superior over conventional penetrating keratoplasty in decreasing postoperative topographic astigmatism, but might have advantages to achieve best-corrected visual acuity and endothelial cell density preservation. In addition, the two techniques seem to be comparable regarding spherical equivalent, graft rejection/failure, and complications.

scholarly journals Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus

2013 ◽  
Vol 2 (3) ◽  
pp. 133-138
Author(s):  
Ramez Barbara ◽  
David Zadok ◽  
Adel Barbara ◽  
Shay Gutfreund
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Corneal Neovascularization ◽  
Young Female ◽  
Spherical Equivalent ◽  
Corrected Visual Acuity ◽  
Optical Zone ◽  
Positive Results ◽  
Oval Shape ◽  
Best Corrected Visual Acuity

ABSTRACT Intacs have yielded positive results for the treatment of keratoconus in terms of reducing the keratometry readings astigmatism and spherical equivalent and consequently improving the uncorrected and best corrected visual acuity. Intacs severe keratoconus (SK) are new design of Intacs with a smaller optical zone (6 mm) and oval shape, they are indicated for severe keratocnus. Pannus is one of the complications of Intacs, as it has never been reported after Intacs SK. We report on corneal neovascularization in the corneal periphery which developed few months after Intacs SK implantation in the cornea of a young female who suffered from advanced keratoconus. The uncorrected visual (UCVA) acuity was satisfactory and the Intacs SK where not removed. Four years after the implantation she presented to our clinic complaining about eye irritation and photophobia, lipid keratopathy was observed. We gave here the choice of explanting the Intacs SK or to try to treat the neovascularization by subconjunctival Avastin, she preferred the second option because of a satisfactory UCVA (0.9). Avastin was injected in the subconjunctival, 10 weeks later Avastin and Kenelog were injected in the subconjunctival, few days after the second injection perforation and melting developed in the cornea, the patient underwent a tectonic graft and few months later penetrating keratoplasty with no intraoperative or postoperative complications. How to cite this article Barbara A, Zadok D, Gutfreund S, Barbara R. Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus. J Kerat Ect Cor Dis 2013;2(3):133-138.

scholarly journals Correction of postkeratoplastic astigmatism by intrastromal corneal segments implantation using a femtosecond laser

2021 ◽  
Vol 6 (6-1) ◽  
pp. 48-55
Author(s):  
N. A. Pozdeyeva ◽  
M. V. Sinitsyn ◽  
A. E. Terentieva ◽  
O. V. Shlenskaya
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Penetrating Keratoplasty ◽  
Biomechanical Properties ◽  
Corneal Graft ◽  
Corneal Resistance Factor ◽  
Astigmatism Correction ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Best Corrected Visual Acuity

Background. After penetrating keratoplasty, mild to high induced corneal astigmatism was observed in each case. The existing choice of correction of postkeratoplastic astigmatism is aimed at fi nding an individual approach in order to compensate for it and not weaken the biomechanical properties of the corneal graft.The aim: to analyze the clinical, functional, and morphological results of postkeratoplastic astigmatism correction by implantation of intrastromal corneal segments using a femtosecond laser.Methods. 22 patients were examined before and 1 year after surgery. The operation was performed under local anesthesia: stage I – an intrastromal tunnel was formed using a femtosecond laser “Femto Visum” 1 MHz (Optosystems, Russia); stage II – the intrastromal corneal segments were implanted. The results were assessed using standard and special research methods using optical coherence tomography Visante OCT (Zeiss, Germany), keratotopography (Tomey-5, Japan), optical corneal analyzer ORA (Reichert, USA), laser tindalemetry FC-2000 (Kowa, Japan) and confocal microscope Confoscan-4 (Nidek, Japan).Results. Before the operation, uncorrected visual acuity averaged 0.09 ± 0.05, after a year – 0.50 ± 0.16; best corrected visual acuity – 0.30 ± 0.12 and 0.60 ± 0.05 respectively; cylindrical component of refraction – –10.29 ± 3.12 and –2.20 ± 0.64 D respectively; mean keratometry value – 43.59 ± 2.14 and 38.56 ± 1.75 D respectively; corneal hysteresis – 7.92 ± 1.22 and 8.95 ± 1.05 mm Hg respectively; corneal resistance factor – 7.01 ± 1.81 and 8.44 ± 1.44 mm Hg respectively; protein fl ux in the moisture of the anterior chamber – 2.97 ± 0.28 and 3.04 ± 0.24 f/ms respectively; endothelial cell density – 1521 ± 327 and 1475 ± 419 cells/mm2 respectively.Conclusion. Intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has efficiency and safety method in correcting postkeratoplastic astigmatism.

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

2021 ◽  
Author(s):  
Sonja Heinzelmann ◽  
Daniel Böhringer ◽  
Philip Christian Maier ◽  
Berthold Seitz ◽  
Claus Cursiefen ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Cost Benefit ◽  
Topical Steroids ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Open Questions ◽  
The Face

Abstract Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

Femtosecond laser-assisted deep anterior lamellar keratoplasty: A safer option in keratoconus surgery

2021 ◽  
pp. 112067212110590
Author(s):  
Cristina Monterosso ◽  
Marco Antonini ◽  
Antonio Di Zazzo ◽  
Daniele Gaudenzi ◽  
Luigi Caretti ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Persistent Epithelial Defect ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity ◽  
Persistent Epithelial Defects

Purpose To evaluate postoperative safety of femtosecond laser deep anterior lamellar keratoplasty performed with an innovative anvil profile in keratoconus patients. Methods This is a single-center, retrospective cohort study. We reviewed medical records of 89 keratoconus patients that underwent femtosecond laser deep anterior lamellar keratoplasty surgery (46 eyes) and manual deep anterior lamellar keratoplasty (47 eyes). Inclusion criteria required: age > 18 years old, best-corrected visual acuity < 0.3 LogMAR, continuous suture of the graft, postoperative immunomodulant regimen with dexamethasone 0.1% for 6 months and at least 12 months follow-up. Previous eye surgery, hydrops, and other ocular disease were excluded. The main outcome measures were postoperative events: rejections, persistent epithelial defects, and graft failures. Results During the follow-up (20 ± 6 months) graft rejection was diagnosed in 0 of femtosecond laser deep anterior lamellar keratoplasty versus 6 (17%) of manual deep anterior lamellar keratoplasty [ p 0.027], persistent epithelial defect in 0 of femtosecond laser deep anterior lamellar keratoplasty versus in 4 (11%) of manual deep anterior lamellar keratoplasty [ p 0.048] and graft failure occurred in 4 (11%) of manual deep anterior lamellar keratoplasty. The best-corrected visual acuity, after removal of sutures, was better in the femtosecond laser deep anterior lamellar keratoplasty group 0.09 ± 0.08 LogMAR versus 0.16 ± 0.13 LogMAR in manual deep anterior lamellar keratoplasty [ p 0.035] group although refractive spherical equivalent and cylinder, topographic average keratometry and cylinder were similar. Conclusions Anvil-shaped femtosecond laser deep anterior lamellar keratoplasty in keratoconus surgery increases safety and readiness of recovery, decreasing the incidence of corneal rejection, epithelial defects, graft failures, and producing better best-corrected visual acuity after removal of sutures.

scholarly journals Non-Descemet Stripping Automated Endothelial Keratoplasty for Bullous Keratopathy in Buphthalmic Eye

2016 ◽  
Vol 7 (2) ◽  
pp. 279-284 ◽  
Author(s):  
Koji Hirano ◽  
Shu Kachi ◽  
Masako Matsuura ◽  
Kazuhide Kawase ◽  
Won Sun Park
Keyword(s):  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Crystalline Lens ◽  
Bullous Keratopathy ◽  
Topical Steroids ◽  
Endothelial Keratoplasty ◽  
Corrected Visual Acuity ◽  
The Right ◽  
Phakic Eyes

Purpose: To report the 2-year follow-up findings in a patient with buphthalmic bullous keratopathy (BK) who was successfully treated with non-Descemet stripping automated endothelial keratoplasty (nDSAEK). Methods: A 39-year-old man had an endothelial graft of 8.0 mm diameter placed uneventfully using the nDSAEK method for phakic BK with buphthalmos of the left eye. He had had a penetrating keratoplasty in the right eye due to aphakic BK 5 years earlier, which, however, resulted in the invasion of blood vessels and graft failure. Since the left eye was phakic, Descemetorhexis was not performed because the instruments might touch the crystalline lens. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at 2 weeks, and at 1, 3, 6, 12, 18 and 24 months after nDSAEK. Results: Twenty-four months after nDSAEK, his left cornea and lens remained clear, and the decimal BCVA was 0.8. However, the ECD of the graft had decreased from 2,274 cells/mm2 before nDSAEK to 539 cells/mm2 24 months after the surgery, and the rate of decrease appeared to be slightly faster than that of former reports. An IOP of >30 mm Hg was recorded at around 2 months after the surgery, but was well controlled by tapering the topical steroids and the addition of topical brinzolamide and latanoprost. Conclusion: Our findings show that nDSAEK can be successfully used to treat buphthalmic BK. We recommend that nDSAEK be considered especially in phakic eyes with a smooth posterior surface around the pupillary area.

Femto Circular Keratotomy to Halt the Progression of Keratoconus I and II

2016 ◽  
Vol 5 (3) ◽  
pp. 109-113
Author(s):  
Jörg H Krumeich ◽  
Nino Hirnschall ◽  
Detlev Breyer ◽  
Florian Laufer
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Statistical Evaluation ◽  
Optical Axis ◽  
Stage I ◽  
Time Points ◽  
Corrected Visual Acuity ◽  
Deep Incision ◽  
Descemet’S Membrane ◽  
Best Corrected Visual Acuity

ABSTRACT Aim To simplify and enhance safety in the generation of a stabilizing intracorneal scar by circular keratotomy (CKT). A femtosecond laser was used to perform individually sized intraparenchymal cuts. Materials and methods As equipped, the Ziemer Z6 femto-second laser cuts a 400-µm-deep incision with a diameter of 7.0 mm around the optical axis. The epithelium, Bowmann's membrane, the internal borders of Descemet's membrane, and the endothelium are not affected. The 3-, 6-, and 12-month postoperative values were compared with the 1-month postoperative keratometric readings and astigmatism. The preoperative best corrected visual acuity (BCVA) with glasses was compared with the values found at the same time points as noted above. Results Statistical evaluation indicated that keratometry within ±1.5D remained in 96.6, 93.1, and 96.6% of cases at the 3-, 6-, and 12-month time points respectively. Astigmatism was stable at the same time points in 100, 95.8, and 92.3%. The BCVA improved in 12 cases throughout the first post-operative year (48%, n = 25); however, 11 cases did not change (44%) and 2 cases lost at least one line (8.0%). Conclusion Femto CKT halts the progression of keratoconus for at least 1 year in 96.6% of cases. This treatment provides keratometric and refractive stability for over 1 year. This result, in conjunction with the significant improvement in BCVA, demonstrates the potential of this method for patients with stage I and II keratoconus. How to cite this article Krumeich JH, Hirnschall N, Breyer D, Laufer F. Femto Circular Keratotomy to Halt the Progression of Keratoconus I and II. Int J Kerat Ect Cor Dis 2016;5(3):109-113.

scholarly journals Simultaneous Phacoemulsification and Graft Refractive Surgery in Penetrating Keratoplasty Eyes

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Sepehr Feizi ◽  
Mohammad Zare ◽  
Bahram Einollahi
Keyword(s):  
Refractive Surgery ◽  
Penetrating Keratoplasty ◽  
Spherical Equivalent ◽  
Iol Implantation ◽  
Acceptable Accuracy ◽  
Corrected Visual Acuity ◽  
Spherical Equivalent Refraction ◽  
Iol Power ◽  
Relaxing Incisions

Purpose. To report outcomes of graft refractive surgery (GRS) along with clear-cornea phacoemulsification and intraocular lens (IOL) implantation in penetrating keratoplasty (PKP) eyes. Methods. Fourteen eyes of 13 patients who had received PKP underwent simultaneous GRS (relaxing incisions with or without counter-quadrant compression sutures) and clear-cornea phacoemulsification with IOL implantation. To calculate IOL power, preoperative keratometry readings and the SRK-T formula were used. Results. Mean patient age and follow-up period were years and months, respectively. A significant increase was observed in best spectacle-corrected visual acuity (from logMAR to logMAR, ). There was a significant decrease in vector keratometric astigmatism by 6.22 D (). Spherical equivalent refraction was reduced from  D to  D () which did not significantly differ from the target refraction ( D, ). No complications developed and all the grafts remained clear at the final examination. Conclusion. Simultaneous phacoemulsification and GRS is a safe and effective method to address post-PKP astigmatism and lens opacity. IOL power can be calculated from preoperative keratometry readings with an acceptable accuracy. However, patients should be informed about the possibility of high refractive errors postoperatively.

scholarly journals Via pars plana anterior iris enclavation IOL fixation

2021 ◽  
Vol 14 (5) ◽  
pp. 774-776
Author(s):  
Tomaso Caporossi ◽  
◽  
Giancarlo Albani ◽  
Francesco Barca ◽  
Fabrizio Giansanti ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Spherical Equivalent ◽  
Choroidal Detachment ◽  
Fixation Technique ◽  
Corrected Visual Acuity ◽  
Pars Plana ◽  
The Mean ◽  
A Prospective Study ◽  
Iol Fixation ◽  
Best Corrected Visual Acuity

AIM: To describe a via pars plana anterior iris enclavation intraocular lens (IOL) fixation technique METHODS: A total of 35 consecutive aphakic vitrectomised patients (average age 71.12±10.12y) underwent pars plana vitrectomy (PPV) and via pars plana anterior iris enclavation IOL fixation. RESULTS: The mean preoperative best corrected visual acuity (BCVA) was 0.11±0.14 logMAR, the mean postoperative BCVA was 0.07±0.11 logMAR. The preoperative mean spherical equivalent was 7.22±4.21 D. The final mean spherical equivalent was -0.25±0.15 D. No eyes had hypotony, retinal or choroidal detachment or endophthalmitis. CONCLUSION: This technique may be a safe and useful in the case of aphakia, and a prospective study would be useful to confirm this findings.

scholarly journals Penetrating Keratoplasty for Keratoconus in Vietnamese Patients

2019 ◽  
Vol 7 (24) ◽  
pp. 4287-4291
Author(s):  
Le Xuan Cung ◽  
Duong Mai Nga ◽  
Nguyen Dinh Ngan ◽  
Nguyen Xuan Hiep ◽  
Do Quyet ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Contact Lenses ◽  
High Rate ◽  
Posterior Subcapsular Cataract ◽  
Corrected Visual Acuity ◽  
Severe Stage ◽  
Hard Contact ◽  
Best Corrected Visual Acuity ◽  
Corneal Disorder

BACKGROUND: Keratoconus is an ectatic corneal disorder that can impair the visual acuity. Up to now, penetrating keratoplasty (PK) remains the most common surgical procedure to treat severe keratoconus. In Vietnam, most keratoconus patients come to visit doctor at severe stage and were treated by PK, so we conduct this study. AIM: To evaluate the results of PK for keratoconus in Vietnamese patients. METHODS: This was a retrospective study of 31 eyes with keratoconus who underwent PK in VNIO from January 2005 to December 2014. RESULTS: The average visual acuity was 0.86 ± 0.37 logMAR (20/145). In the group of patients without amblyopia, best spectacle-corrected visual acuity of 20/60 or better was recorded in 75.9% of eyes and 93.1% of eyes achieved a best corrected visual acuity with hard contact lenses of 20/40 or better. Mean postoperative corneal power was 43.8 ± 4.5D. Mean corneal astigmatism was 5.9 ± 2.7D. 94.6% of grafts remained clear. Posterior subcapsular cataract developed in 22.6% of eyes. Graft rejection was recognized in 12.9% of eyes. CONCLUSION: PK is an effective procedure with high rate of graft survival for keratoconus patients. However, patients should be aware of the necessary of optical correction to gain the best VA after surgery.

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