Purpose to evaluate wound strength for patient safety during transport and endothelial viability when partial and complete femtosecond laserassisted keratoplasty flak incisions are made in cadaveric corneas. Clinical study femtosecond laser assisted deep anterior lamellar keratoplasty outcomes and healing patterns compared to manual technique jorgel. Keratoplasty is the transplantation of all or part of the cornea to repair scarred or damaged tissue. Laser thermal keratoplasty is a noncontact laser refractive surgery procedure. Placement of other sutures done by interrupted sutures single running suture double running suture interrupted sutures recommended in infants and children, highly vascularized corneas and therapeutic keratoplasty knots buried beneath epithelium of recipient or donor preferred in donor to reduce risk of vascularization. These burns cause a ring of constriction on the peripheral cornea causing the cornea to steepen making the eye focus better at near. 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. We utilized a modified intralase that allows up to 1,400. An independent licensee of the blue cross and blue shield association.
Lattice and granular dystrophies can have deeper involvement. A femtosecond laser is a laser which emits ultrashort pulses, used for minimally invasive corneal surgery. Penetrating keratoplasty by pushkar dhir slideshare. Since penetrating keratoplasty pk was first performed more than a century ago, advances in instrumentation have resulted in improved patient outcomes. Femtosecond lasers have been proposed for the dissection of the donor button andor recipient cornea in corneal endothelial keratoplasty 16 and in deep anterior lamellar keratoplasty 17,18 and. Paschalis2,3 abstract the use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. The cornea, a clear, domeshaped membrane that covers the front of the eye, is a key refractive element of the eye. Traditionally a circular blade or trephine is used to mechanically cut a circular incision in both donor and patient. Laser thermal keratoplasty, or ltk, is a type of eye surgery which was introduced in the 1990s to treat longsightedness. Diseases amenable to superficial anterior lamellar keratoplasty include those characterized by superficial irregular opacities such as reisbuckler, granular, and lattice corneal dystrophies figure 10. Treatment of postoperative keratoplasty astigmatism using.
Femtosecond laser assisted keratoplasty flak the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Endothelial keratoplasty pdaek grafts using innovative microkeratome technology dickman mor m, van marion friso wf, wesseling teja, steijgervermaat petra, brekelmans juriaan, berendschot tos tjm, nuijts rudy mma maastricht, beverwijk the netherlands 17. Femtosecond laser assisted keratoplasty full text view. This case was performed for severe corneal edema secondary to pseudophakic bullous. The patients were divided into two groups, 25 eyes each, depending on whether femtosecond. Corneal transplantation or corneal grafting or keratoplasty involves removal of diseased or damaged cornea and its replacement by donated corneal tissue. Indications for cornea transplantation included keratoconus 19, pellucid marginal. Lasik, in which the front of the cornea is removed, frozen, reshaped, and stitched. Endothelial keratoplasty ek is a cornea transplant technique that is the preferred way to restore vision when the inner cell layer of the cornea stops working properly from fuchs dystrophy, bullous keratopathy, iridocorneal endothelial ice syndrome, or other endothelial disorders. Anterior lamellar keratoplasty alk replaces a scarirregularity in the front of the cornea, with a partial thickness tissue, assuming the posterior cornea is normal. The femtosecond laser has had a profound effect on refractive surgery and, more recently, on cataract surgery and cornea transplantation. How flak is changing keratoplasty femtosecond laserassisted keratoplasty yields visual comparable to pkp but with better healing and graft strength.
Onestage femtolaser assisted lamellar keratoplasty and foreign body removal. Penetrating excimer laser keratoplasty was introduced in 2010 in center 1 3%, 9. Femtosecond laserassisted keratoplasty request pdf. The penetrating keratoplasty pkp a century of success. Penetrating keratoplasty pk surgery centre for sight. Taniguchi2,3, michael tsatsos4, rodrigo muller2, colm mcalinden5,6, roberto pineda2 and eleftherios i. Femtosecond laserassisted anterior lamellar keratoplasty the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Allogenic limbokeratoplasty provided a maximum of 10% of keratoplasties in all indications. Rearrange individual pages or entire files in the desired order. Penetrating keratoplasty pk full thickness grafts are being performed less and less often. Keratoplasty the darkened areas represent the tissues that are transplanted. Refractive keratoplasty is surgery to reshape the cornea of the eye to correct vision problems such as myopia nearsightedness and hyperopia farsightedness.
Anterior lamellar grafts were precut with microkeratomes. Descemet stripping automated endothelial keratoplasty dsaek. This procedure is best for scarring that is in the anterior 250 microns of the cornea. The femtolaser assisted keratoplasty was abandoned in 20 in center 1.
The procedure involves using the heat from a laser to shrink a ring of tissue on the cornea, the eyes transparent covering. Clinical outcomes of penetrating keratoplasty performed. Reallife stories bojan pajic, md, phd, orasis ag, reinach, switzerland energy is key jod mehta, md, head of the corneal and external eye disease service of the singapore national eye center figure 2. Endothelial keratoplasty, also referred to as posterior lamellar keratoplasty, is a form of corneal transplantation in which the diseased inner layer of the cornea, the endothelium, is replaced with healthy donor tissue. Methods 19 human corneoscleral rims were divided into six groups, mounted on an anterior chamber maintainer and cut with a femtosecond laser. Clinical study femtosecond laser assisted deep anterior. Onlay lamellar keratoplasty columbia ophthalmology. The procedure employs a holmium laser to place a ring of concentric laser burns on the cornea between 6 mm and 7 mm in diameter. Dalk was performed on 50 eyes of 47 advanced keratoconus patients. Femtosecond laser was used to replace scar tissue located in anterior corneal stroma with healthy donor tissue. The evolution of corneal and refractive surgery with the. Pdf femtosecond laser assisted cataract surgery after.
Keratoplasty with a novel approach gerald schmidinger, md, medical university of vienna, austria low energy femtolaser cataract surgery. The goals of this laboratory study were to evaluate the interface quality in laserassisted lamellar anterior keratoplasty lalak with microkeratomecut grafts and achieve good grafthost apposition. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. In addition, studies of femtosecond laserenabled keratoplasty flek have shown rapid visual recovery and astigmatism comparable with or often better than traditional blade trephination.
Results of femtosecond laserassisted descemet stripping. Ek selectively replaces only the diseased layer of the cornea, leaving healthy areas intact. The number increased to 11% 29 in 2011 and then remained stable at about 5% 20. Penetrating keratoplasty for keratoconus excimer versus. Femtolaser treatment of the crystalline lens may increase safety of the surgery in patients underwent deep anterior lamellar keratoplasty dalk. Femtosecond assisted anterior lamellar keratoplasty falk.
The intralase femtosecond laser provides surgeons with the ability to make very precise incisions in the cornea and these can be combined in a multitude of ways to enhance penetrating keratoplasty or full thickness graft surgery. Safer and less invasive techniques such as dalk deep anterior lamellar keratoplasty and dsaek descemets stripping automated endothelial keratoplasty have. Penetrating keratoplasty using femtosecond laserenabled. Deceased individuals with no known corneal diseases can donate their corneas within 68 hours of their demise.
Manual trephination has evolved to current stateoftheart vacuum trephines such as the hanna trephine, which reliably provide smoothly circular incisions. Analysis of the changes in keratoplasty indications and. Vision is lost if the cornea becomes swollen, cloudy, or damaged from infection, disease, trauma, or aging. To assess the clinical outcomes of femtosecond laserassisted keratoplasty flak using the visumax femtosecond laser system, and to compare them with those of conventional penetrating keratoplasty pk. Review open access the evolution of corneal and refractive surgery with the femtosecond laser antonis aristeidou1, elise v. Femtosecond laser dalk fsdalk corneal transplants cfs. Femtosecond laserassisted anterior lamellar keratoplasty. However, some patients with postoperative penetrating keratoplasty have more severe astigmatism that requires surgical treatment. Listing a study does not mean it has been evaluated by the u. Deep laserassisted lamellar anterior keratoplasty with. This creates a tight band around the eye which steepens the angle of the cornea and serves to make the eye more short.
Refractive keratoplasty procedures include keratomileusis laser assisted in situ keratomileusis. Anterior lamellar keratoplasty american academy of. Simulated lalak surgeries were performed on 6 pairs of eyebank corneoscleral discs. The cornea is the clear, outermost layer of the eye. Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue the graft. Descemet stripping automated endothelial keratoplasty dsaek is an endothelial replacement procedure in which dysfunctional corneal endothelium is replaced with a graft consisting of donor endothelium and a thin layer of posterior stroma to facilitate handling of the tissue. Outcomes of femtosecond laserassisted mushroomconfiguration keratoplasty in advanced keratoconus. It is a retrospective comparative surgical case series of 116 keratoconus patients 7 eyes who had pkp at the cornea eye institute, beverly hills, california, usa. We have previously reported on the use of the femtosecond laser to perform top hatshaped penetrating keratoplasty pkp. Tolees ss, eldanasoury am, hashem a 2014 femtosecond laser assisted cataract surgery after deep lamellar keratoplasty. Keratoplasty an operation in which diseased corneal tissue is replaced by donor corneal tissue vp filatov father of keratoplasty penetrating keratoplasty lamellar keratoplasty ant. Penetrating keratoplasty pk corneal transplant consent form.