Femtosecond laser‐assisted minimally invasive lamellar keratoplasty for the treatment of advanced keratoconus

Abstract

Background: To evaluate the initial safety and efficacy of femtosecond laserassisted minimal invasive lamellar keratoplasty (FL-MILK) for advanced keratoconus. Methods: Twenty-two patients (22 eyes) with advanced keratoconus were included in this prospective study. All the involved eyes underwent FL-MILK.The femtosecond laser was used to create an intrastromal pocket with a 2.3 mm incision in the recipient cornea. Then a stromal button with a diameter of 9.0 mm and a depth of 200 μm was gently inserted into the intrastromal pocket through the 2.3 mm incision and flattened. No sutures were applied.Follow-up was conducted for 24 months.Results: Twenty-two patients completed follow-up data for 12 months, 16 patients had 24 months follow-up. No epithelial implantation, infection or allogeneic rejection were observed during the follow-up. Based on baseline values, postoperative 12 months values and postoperative 24 months values, clinical significantly improvement was recorded in corrected distance visual acuity (CDVA) (0.40 ± 0.18 logMAR vs. 0.30 ± 0.12 logMAR and 0.23 ± 0.13 logMAR), the anterior central corneal elevation (29.14 ± 15.33 μm vs. 14.45 ± 13.75μm and 11.38 ± 8.33 μm), and corneal higher-order aberrations (3.536 ± 1.503 vs. 2.761 ± 1.517 and 0.994 ± 0.391). Corneal biomechanical properties in all eyes improved significantly. SP-A1 increased from 48.64 ± 12.87 preoperatively to 87.26 ± 21.01 postoperative 12 months and 88.77 ± 18.26 postoperative 24 months; deformation amplitude (DA) decreased from 1.36 ± 0.15 preoperatively to 1.21 ± 0.12 postoperative 12 months and 1.19 ± 0.19 postoperative 24 months.Conclusions: Initial experience suggests that this minimally invasive transplantation may be a feasible option for advanced keratoconus. A larger cohort and longer follow-up are required to validate our results and establish longterm safety and efficacy of the procedure.Hua Gao and Weiyun Shi contributed equally to this manuscript.

Single-cell atlas of keratoconus corneas revealed aberrant transcriptional signatures and implicated mechanical stretch as a trigger for keratoconus pathogenesis

“…To comprehensively understand the cellular diversity and molecular signatures of the human cornea from keratoconus and healthy control individuals, we isolated corneal cells from three central cornea tissues (without endothelium) of keratoconus patients after deep anterior lamellar keratoplasty (DALK) surgeries 34,35 and four control samples from healthy donors (Supplementary Table S1, see Materials and Methods for details). Tissues from each sample were dissociated and subjected to 10x Genomics platforms for scRNA-Seq, separately (Fig.…”

Distribution of pediatric keratoconus by different age and gender groups

“…Pediatric keratoconus tends to present more aggressively compared to adult patients ( 12 , 16 ). Patients with an early onset age appear to have a more severe form of keratoconus, with an increased likelihood of corneal opacities and the subsequent need for keratoplasty ( 11 , 16 , 26 ). In addition, the diagnosis of pediatric keratoconus is often delayed because of few functional complaints and unspecified characteristics ( 13 , 15 , 17 ).…”

Investigation of contrast visual acuity with rigid gas permeable contact lenses after penetrating Keratoplasty

“…Corneal transplantation is the main approach to restoring the sight of patients with corneal blindness, [ 1 – 3 ] but the surgery usually induces irregularity of the front corneal surface, leading to poor postoperative visual acuity despite the correction with spectacles [ 4 – 6 ]. Although the implanted corneal graft becomes transparent, the poor visual performance may still affect the quality of life [ 7 – 9 ].…”