Femtosecond laser-assisted anterior lamellar keratoplasty for the treatment of stromal corneal pathology

Purpose: To compare the visual outcome of femtosecond laser-assisted anterior keratoplasty (FSALK) and microkeratome-assisted anterior lamellar keratoplasty (MALK) in anterior corneal dystrophy. Methods: retrospective comparative chart review of 7 eyes that underwent FSALK and 7 eyes that underwent MALK. The primary outcome was the visual outcome of both procedures. The secondary outcome was the recurrence of the corneal dystrophies.Results: Mean follow-up time was 30±14(7-51) months for the FSALK group and 127±28(80-127) months for the MALK group. In the FSALK group the preoperative best spectacle-corrected visual acuity (BSCVA) improved from 20/63 to 20/25 at 36 months. In the MALK group there was 1 eye with documented BSCVA over 36 months follow-up; it improved from 20/160 preoperatively to 20/32 at 36 months. Uncorrected visual acuity (UCVA) at 36 months improved from 20/100 preoperatively to 20/63 in the FSALK group and from 20/200 preoperatively to 20/63 in the MALK group. Five eyes with Reis-Bucklers showed a clinical recurrence at a mean of 142±13(125-152) months. Two eyes with granular dystrophy showed a clinical recurrence at 23 and 80 months of follow-up. One eye in the MALK group had epithelial ingrowth. One eye in the FSALK group with compromised ocular surface due to 2 previous penetrating keratoplasty, suffered bacterial keratitis that ended up with corneal scarring. Conclusion: Both procedures improve visual outcome for anterior corneal dystrophy. FSALK has theoretical advantages over MALK; however, larger prospective studies are needed to prove this.

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

European Journal of Ophthalmology ◽

10.1177/11206721211059023 ◽

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.

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The Big-Bubble Full Femtosecond Laser-Assisted Technique in Deep Anterior Lamellar Keratoplasty

Journal of Refractive Surgery ◽

10.3928/1081597x-20151111-07 ◽

2015 ◽

Vol 31 (12) ◽

pp. 830-834 ◽

Cited By ~ 1

Author(s):

Luca Buzzonetti ◽

Gianni Petrocelli ◽

Paola Valente ◽

Giancarlo Iarossi ◽

Roberta Ardia ◽

...

Keyword(s):

Femtosecond Laser ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Anterior Lamellar Keratoplasty ◽

Big Bubble

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Refractive outcome of keratoconus treated by big-bubble deep anterior lamellar keratoplasty in pediatric patients: two-year follow-up comparison between mechanical trephine and femtosecond laser assisted techniques

Eye and Vision ◽

10.1186/s40662-018-0127-9 ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Luca Buzzonetti ◽

Gianni Petrocelli ◽

Paola Valente ◽

Sergio Petroni ◽

Rosa Parrilla ◽

...

Keyword(s):

Femtosecond Laser ◽

Pediatric Patients ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Refractive Outcome ◽

Anterior Lamellar Keratoplasty ◽

Big Bubble

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Femtosecond-Laser Assisted Deep Anterior Lamellar Keratoplasty (F-DALK)

10.1007/978-3-030-84506-3_13 ◽

2021 ◽

pp. 213-222

Author(s):

Gerald Schmidinger ◽

Theo G. Seiler ◽

Ruth Donner

Keyword(s):

Femtosecond Laser ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Anterior Lamellar Keratoplasty

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Comparative Study of Corneal Endothelial Cell Damage after Femtosecond Laser Assisted Deep Stromal Dissection

BioMed Research International ◽

10.1155/2014/731565 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Ting Liu ◽

Jingjing Zhang ◽

Dapeng Sun ◽

Wenjie Sui ◽

Yangyang Zhang ◽

...

Keyword(s):

Femtosecond Laser ◽

Cell Damage ◽

Endothelial Damage ◽

Lamellar Keratoplasty ◽

Control Group ◽

Electron Microscopic ◽

Anterior Lamellar Keratoplasty ◽

Bed Thickness ◽

Scanning Electron

Purpose.To find a relatively safe designed stromal bed thickness to avoid endothelial damage for lamellar keratoplasty with an Allegretto Wavelight FS200 femtosecond laser.Methods.Twelve rabbits were randomly divided into 50 μm and 150 μm groups according to the anticipated residue stromal bed thickness preparation with a femtosecond laser. Six rabbits without laser cutting were used as a control group. Central endothelial images were analyzed with in vivo confocal microscopy and scanning electron microscopy. The apoptosis of endothelium was evaluated with Hoechst 33342 staining and a TUNEL assay.Results.The endothelium of the 50 μm group had extensive injuries upon in vivo confocal and scanning electron microscopic observation, and minor injuries were observed in the 150 μm group. Moreover, more apoptotic cells were observed in the 50 μm group.Conclusions.When using a FS200 femtosecond laser assisted anterior lamellar keratoplasty, there was minor endothelium damage with a 150 μm stromal bed, and a more than 150 μm thickness stromal bed design may prevent the damage of corneal endothelium.

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