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

El-Husseiny, M; Seitz, Berthold; Langenbucher, Achim; Akhmedova, Elena; Szentmáry, Nóra; Häger, Tobias; Tsintarakis, Themistoklis; Janunts, Edgar

doi:10.1155/2015/645830

Cited by 17 publications

(10 citation statements)

References 23 publications

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“…( 9 ), analogue). The eight lines which are applied, for example with the Intralase femtosecond laser, in the donor and recipient can often not be brought into complete alignment intra-operatively in the keratoconus eye [ 1 , 39 ] (Fig. 12 ).…”

Section: Results Of the Prospective Randomised Studymentioning

confidence: 99%

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Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

Seitz¹,

Langenbucher²,

Häger³

et al. 2017

TOOPHTJ

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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.

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Section: Results Of the Prospective Randomised Studymentioning

confidence: 99%

“…With FSL PKP, the stitch depth was intended pre-Descemet’s and not to the plane of the side cut. The first suture were removed after 1 year, the second suture was removed after 1.5 years under topical anaesthesia [ 39 ].…”

Section: Results Of the Prospective Randomised Studymentioning

confidence: 99%

Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

Seitz¹,

Langenbucher²,

Häger³

et al. 2017

TOOPHTJ

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“…After laser trephination, the corneal button was removed with forceps and a spatula under microscopic control. If necessary, microscissors were used to complete the incision [13].…”

Section: Patientsmentioning

confidence: 99%

Endothelial cell density and corneal graft thickness following excimer laser vs. femtosecond laser-assisted penetrating keratoplasty—a prospective randomized study

Tóth

Butskhrikidze

Seitz

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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Purpose The study aims to compare the impact of non-mechanical excimer laser-assisted (EXCIMER) and femtosecond laserassisted (FEMTO) trephinations on graft endothelial cell density (ECD) and graft thickness before and after suture removal following penetrating keratoplasty (PK). Methods The inclusion criteria for this prospective, randomized, clinical study were as follows: (1) surgeries performed by one surgeon; (2) primary central PK; (3) keratoconus (KC) or Fuchs' dystrophy (FUCHS); (4) no previous intraocular surgery; (5) graft oversize, 0.1 mm; and (6) 16-bite double-running suture. In 68 eyes of 68 patients (mean age: 53.3 ± 19.8 years), PK was performed using either 193-nm MEL70 excimer laser (BEXCIMER^: 17 KC, 18 FUCHS) or 60-KHz femtosecond laser (BFEMTO^: 17 KC, 16 FUCHS) trephination. Specular microscopy (EM 3000) and pachymetry (EM 3000; Pentacam HR; Casia SS-1000) were performed before removing the first suture (11.4 ± 1.9 months) and after removing the second suture (22.6 ± 3.8 months), but before any additional ophthalmic surgery. Results ECD did not differ significantly (P ≥ 0.436) between EXCIMER and FEMTO either with Ball-sutures-in^(1887 ± 409 vs. 1886 ± 438) or with Ball-sutures-out^(1703 ± 379 vs. 1737 ± 362). Central corneal thickness and corneal thickness at the thinnest point of the cornea did not differ significantly between EXCIMER and FEMTO either with all-sutures-in (P ≥ 0.096 and P ≥ 0.653) or with all-sutures-out (P ≥ 0.636 and P ≥ 0.717). Conclusions EXCIMER and FEMTO trephinations from the epithelial side seem to have no disadvantages regarding endothelial cell loss after PK, and both surgical procedures are safe for the endothelium. A larger sample size and longer follow-up are needed to evaluate the long-term impact of EXCIMER and FEMTO trephinations on ECD.

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“…A femtoszekundumlézer szaruhártyára kifejtett hatását -a precíz szöveti metszést -a rendkívül gyors, 220-580 fs időtartamú lézerimpulzusoknak köszönheti (1 fs = 10 -15 s). Ezáltal a metszési, vágási idő nemcsak rendkívüli módon pontos, hanem jelentősen lerövidül, szemben a korábbi excimerlézeres trepanációval [4,5].…”

Section: Eredeti Közleményunclassified

Femtoszekundumlézeres keratoplasztika

et al. 2018

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

Cited by 17 publications

References 23 publications

Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

Endothelial cell density and corneal graft thickness following excimer laser vs. femtosecond laser-assisted penetrating keratoplasty—a prospective randomized study

Femtoszekundumlézeres keratoplasztika

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