scholarly journals 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

2019 ◽  
Vol 6 (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

scholarly journals Femtosecond Laser and Big-Bubble Deep Anterior Lamellar Keratoplasty: A New Chance

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Luca Buzzonetti ◽  
Gianni Petrocelli ◽  
Paola Valente
Keyword(s):  
Femtosecond Laser ◽  
Intraoperative Complications ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Spherical Equivalent ◽  
Scheimpflug Camera ◽  
Refractive Outcomes ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble

Purpose. To report the 12-month follow-up after big-bubble deep anterior lamellar keratoplasty (DALK) assisted by femtosecond laser that we have called IntraBubble.Methods. A 60 kHz IntraLase femtosecond laser (Abbott Medical Optics) firstly created a 30°angled intrastromal channel to insert the air injection cannula, 50 μ above the thinnest corneal site measured by Sirius Scheimpflug camera (CSO, Firenze, Italy), then performed a full lamellar cut 100 μ above the thinnest corneal point, and from the same corneal depth, created a mushroom incision. The lamella was removed, and the smooth cannula of Fogla was inserted into the stromal channel and air was injected to achieve a big bubble. The follow up is 12 months, and sutures were removed by the 10th postoperative month in all patients. Best Corrected Visual Acuity (BCVA), spherical equivalent and, by Sirius Scheimpflug camera (CSO, Firenze, Italy) keratometric astigmatism were evaluated.Results. All procedures were completed as DALK except 2 converted to PK because an inadvertent intraoperative macroperforation occurred. Mean postoperative BCVA was 0.8, mean spherical equivalent was-3.5±1.7 D, and mean keratometric astigmatism was4.8±3.1 D.Conclusion. The femtosecond laser could standardize the big-bubble technique in DALK, reducing the risk of intraoperative complications and allowing good refractive outcomes.

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.

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

2015 ◽  
Vol 31 (12) ◽  
pp. 830-834 ◽  
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

Comparison between manual trephination versus femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus

2019 ◽  
pp. bjophthalmol-2018-313365 ◽  
Author(s):  
Ramin Salouti ◽  
Mohammad Zamani ◽  
Maryam Ghoreyshi ◽  
Isabel Dapena ◽  
Gerrit R.J. Melles ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Manifest Refraction ◽  
Comparative Clinical Study ◽  
The Mean

Background/aimsTo compare the outcomes of femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) versus manual trephination DALK (M-DALK) in patients with keratoconus.MethodsIn this retrospective, comparative, clinical study, medical charts of 860 patients with keratoconus who underwent F-DALK (n=391) or M-DALK (n=469) with the Melles’s technique, and had at least a 12-month follow-up record were reviewed. The main outcome measures comprised best spectacle-corrected visual acuity (BSCVA), manifest refraction and keratometric indices. The postsurgical measurements were recorded for all patients at 12 months (suture-in condition), and a subset of patients with complete data at 24 months (suture-out condition; 111 F-DALK and 282 M-DALK cases).ResultsBoth procedures had comparable mean (±SD) logMAR BSCVA at 12 months (0.18±0.12 for M-DALK and 0.17±0.12 for F-DALK; p=0.224) and 24 months (0.11±0.10 vs 0.09±0.09, respectively; p=0.166) examinations. M-DALK was associated with a significant more residual myopia at 12 months (−3.85±3.27 vs -1.94±2.86 D; p<0.001), and a milder similar trend at 24 months follow-up (−2.94±2.72 vs −2.38±2.65 D, p=0.064). The mean keratometry (12 months: 46.15±1.88 vs 44.39±1.72, p<0.001; 24 months: 45.33±2.37 vs 44.14±1.68, p<0.001) and apical keratometry values (12 months: 50.92±5.00 vs 47.13±2.38, p<0.001; 24 months: 50.29±4.25 vs 48.12±3.81) were significantly greater for M-DALK than F-DALK, while the keratometric astigmatism was similar (12 months: 2.62±1.58 vs 2.53±1.33, p=0.364; 24 months: 3.21±1.83 vs 3.34±1.88, p=0.529).ConclusionsF-DALK for advanced keratoconus performs as well as M-DALK in terms of BSCVA and keratometric astigmatism in both suture-in (12 months) and suture-out (24 months) conditions. It might have advantages over M-DALK for residual myopia and restoring corneal anatomy.

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