Femtosecond laser-assisted in situ keratomileusis for the correction of residual ametropia after deep anterior lamellar keratoplasty: a pilot investigation

Abstract

PurposeTo evaluate the refractive and visual results of one-stage laser-assisted in situ keratomileusis with femtosecond laser (Femto-LASIK) for the correction of residual ametropia after deep anterior lamellar keratoplasty (DALK).MethodsThis retrospective study included 13 eyes of 12 patients, who underwent corneal Femto-LASIK to correct refractive errors after DALK. IntraLase FS150 was used to create a lamellar flap and excimer laser ablation for refractive correction was performed using the Star S4 IR Excimer Laser in eight cases and the Technolas 217z Excimer Laser in Tissue Saving mode in five cases. Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction and corneal topography.ResultsThe mean spherical equivalent preoperatively was -4.85±2.82 (range, -9.5 to 0 D). At the last visit the mean postoperative spherical equivalent (SE) was -0.44±0.67 D (P<0.05). The mean postoperative UDVA was 0.12±0.12 logMAR. There was a statistically significant increase in CDVA 6 months after Femto-LASIK (P<0.05). Intraoperative and postoperative complications did not develop in this series of eyes.ConclusionsCorrecting the preoperative manifest refractive error with Femto-LASIK led to a significant improvement in the UDVA and CDVA without surgical complications.

<p>Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty: Retrospective Case Series Analysis With Long-Term Follow-Up</p>

“…The magnitude of the baseline spherical error (range +3.0 to −13.0 D) and cylindrical error (range −2.0 to −11.0 D) of this case series reflect the wide field of power range provided by phakic IOLs. These baseline refractive values were much higher than those revealed in most of the reports of LASIK postkeratoplasty, including DALK 15,16. Moreover, the percentage of reduction in refractive astigmatism (83.8±15.8%) was higher when compared to LASIK after keratoplastly, which varies from 48% to 88% in different reports of the literature 19–24…”

“…Several surgical options to correct refractive errors after DALK have been reported in the literature, such as PRK,13,14 LASIK,15,16 small incision lenticule extraction17 and corneal relaxing incisions 18. In addition, phakic IOLs implantation have also been satisfactorily used for visual rehabilitation after DALK in more recent reports 7,10–12…”

Three-year follow-up of posterior chamber phakic intraocular lens with a central port design after deep anterior lamellar keratoplasty

“…To overcome this, a variety of refractive surgical procedures have been evaluated. Corneal refractive procedures have shown encouraging results [ 28 – 31 ], however, these options were not appropriate in this group of eyes because of high myopia and astigmatism, dry eye and/or low corneal thickness for the attempted refractive error.…”

“…However, in younger patients, this aspect should be assessed preoperatively. Although LASIK and PRK have shown efficacy and safety in post-DALK [ 28 – 31 ], and a laser touch-up can be effectively and safely planned, this risk should be evaluated and explained to the patients.…”

A Clinical Case of Treatment of a Patient With Bowman's Reis-Bucklers Membrane Dystrophy by Inverted Topography-Guided Photorefractive Keratectomy

“…Следовательно, не исключается возможность рецидивирующего характера данного заболевания, что требует повторного хирургического лечения или поиска нового способа борьбы с ним. Также весьма вероятно возникновение и других послеоперационных проблем, например высокого риска отторжения роговичного трансплантата, низкой некорригированной остроты зрения, обусловленной посткератопластической аметропией [11,12,13]. При попытке выполнения операции ФРК хирурги сталкиваются с рядом проблем, обусловленных наличием иррегулярности, асимметрии и помутнения роговой оболочки, а также с тем, что эпителий роговицы при нарушении прозрачности в ее поверхностных слоях скрывает иррегулярность стромы и боуменовой мембраны.…”