scholarly journals Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Moatasem El-Husseiny ◽  
Berthold Seitz ◽  
Achim Langenbucher ◽  
Elena Akhmedova ◽  
Nora Szentmary ◽  
...  
Keyword(s):  
Femtosecond Laser ◽  
Excimer Laser ◽  
Outcome Measures ◽  
Penetrating Keratoplasty ◽  
Positive Pressure ◽  
Group Iii ◽  
Fuchs Dystrophy

Purpose. To assess the intraoperative results comparing two non-mechanical laser assisted penetrating keratoplasty approaches in keratoconus and Fuchs dystrophy.Patients and Methods. 68 patients (age 18 to 87 years) with keratoconus or Fuchs dystrophy were randomly distributed to 4 groups. 35 eyes with keratoconus and 33 eyes with Fuchs dystrophy were treated with either excimer laser ([Exc] groups I and II) or femtosecond laser-assisted ([FLAK] groups III and IV) penetrating keratoplasty. Main intraoperative outcome measures included intraoperative decentration, need for additional interrupted sutures, alignment of orientation markers, and intraocular positive pressure (vis a tergo).Results. Intraoperative recipient decentration occurred in 4 eyes of groups III/IV but in none of groups I/II. Additional interrupted sutures were not necessary in groups I/II but in 5 eyes of groups III/IV. Orientation markers were all aligned in groups I/II but were partly misaligned in 8 eyes of groups III/IV. Intraocular positive pressure grade was recognized in 12 eyes of groups I/II and in 19 eyes of groups III/IV. In particular, in group III, severe vis a tergo occurred in 8 eyes.Conclusions. Intraoperative decentration, misalignment of the donor in the recipient bed, and need for additional interrupted sutures as well as high percentage of severe intraocular positive pressure were predominantly present in the femtosecond laser in keratoconus eyes.

scholarly journals Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

2017 ◽  
Vol 11 (1) ◽  
pp. 225-240 ◽  
Author(s):  
Berthold Seitz ◽  
Achim Langenbucher ◽  
Tobias Hager ◽  
Edgar Janunts ◽  
Moatasem El-Husseiny ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Excimer Laser ◽  
Penetrating Keratoplasty ◽  
Contact Lenses ◽  
Corneal Transplantation ◽  
Correction Method ◽  
Good Prognosis ◽  
Severe Stage ◽  
First Choice

Background: In case of keratoconus, rigid gas-permeable contact lenses as the correction method of first choice allow for a good visual acuity for quite some time. In a severe stage of the disease with major cone-shaped protrusion of the cornea, even specially designed keratoconus contact lenses are no more tolerated. In case of existing contraindications for intrastromal ring segments, corneal transplantation typically has a very good prognosis. Methods: In case of advanced keratoconus – especially after corneal hydrops due to rupture of Descemet’s membrane – penetrating keratoplasty (PKP) still is the surgical method of first choice. Noncontact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and those with repeat grafts in case of “keratoconus recurrences” due to small grafts with thin host cornea. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved with a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually depending on corneal size („as large as possible – as small as necessary“). Limbal centration will be preferred intraoperatively due to optical displacement of the pupil. During the last 10 years femtosecond laser trephination has been introduced from the USA as a potentially advantageous approach. Results: Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces “vertical tilt” and “horizontal torsion” of the graft in the recipient bed, thus resulting in significantly less “all-sutures-out” keratometric astigmatism (2.8 vs. 5.7 D), higher regularity of the topography (SRI 0.80 vs. 0.98) and better visual acuity (0.80 vs. 0.63) in contrast to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. Refractive outcomes of femtosecond laser keratoplasty, however, resemble that of the motor trephine. Conclusions: In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination with intraoperative pitfalls and high postoperative astigmatism.

Comparison of Excimer Laser Versus Femtosecond Laser Assisted Trephination in Penetrating Keratoplasty: A Retrospective Study

2019 ◽  
Vol 36 (12) ◽  
pp. 3471-3482 ◽  
Author(s):  
Gábor Tóth ◽  
Nóra Szentmáry ◽  
Achim Langenbucher ◽  
Elina Akhmedova ◽  
Moatasem El-Husseiny ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Femtosecond Laser ◽  
Excimer Laser ◽  
Penetrating Keratoplasty

Femtosecond laser assisted penetrating keratoplasty

2006 ◽  
Vol 223 (S 1) ◽  
Author(s):  
MP Holzer ◽  
TM Rabsilber ◽  
GU Auffarth
Keyword(s):  
Femtosecond Laser ◽  
Penetrating Keratoplasty

Lamellar Corneal Resection with LDV Crystal Line Femtosecond Laser after Penetrating Keratoplasty

2012 ◽  
pp. 99-99
Author(s):  
Bojan Pajic ◽  
Brigitte Pajic-Eggspuehler ◽  
Franz Fankhauser ◽  
Slobodanka Latinovic ◽  
Farhad Hafezi ◽  
...  
Keyword(s):  
Femtosecond Laser ◽  
Penetrating Keratoplasty

scholarly journals Positive pressure during penetrating keratoplasty can be solved with a modified graft-over-host technique

2013 ◽  
Vol 92 (3) ◽  
pp. 282-285 ◽  
Author(s):  
Iva Dekaris ◽  
Nikica Gabrić ◽  
Maja Pauk ◽  
Nataša Drača
Keyword(s):  
Penetrating Keratoplasty ◽  
Positive Pressure

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.

Safety and efficacy of femtosecond laser–assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty

2015 ◽  
Vol 41 (6) ◽  
pp. 1168-1175 ◽  
Author(s):  
Ali Fadlallah ◽  
Chadi Mehanna ◽  
Jean-Jacques Saragoussi ◽  
Elias Chelala ◽  
Belkacem Amari ◽  
...  
Keyword(s):  
Femtosecond Laser ◽  
Penetrating Keratoplasty ◽  
Safety And Efficacy ◽  
Irregular Astigmatism
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