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Du K, Liu E, Li N, Yuan B, Peng R, Hong J. Comparison of Femtosecond Laser Assistance and Manual Trephination in Deep Anterior Lamellar Keratoplasty in the Treatment of Keratoconus: A Meta-Analysis. Am J Ophthalmol 2023; 256:126-137. [PMID: 37553035 DOI: 10.1016/j.ajo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To compare the efficacy and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) with those of manual-trephination DALK (M-DALK) in treating keratoconus. DESIGN Systematic review and meta-analysis. METHODS Through November 2022, we comprehensively searched PubMed, EMBASE, the Cochrane Library, and 4 Chinese databases. Studies that involved comparisons between F-DALK and M-DALK groups and that reported on relevant efficacy and/or safety parameters were included. Primary outcomes were uncorrected- and corrected-distance visual acuity and intraoperative complication rates. Secondary outcomes were spherical equivalent, topographic astigmatism, refractive cylinder, mean keratometry, endothelial cell density, suture removal time, and postoperative complication rates. These data were analyzed using Cochrane Review Manager software version 5.3. RESULTS This meta-analysis included 9 nonrandomized controlled studies involving 1713 eyes. In eyes treated with F-DALK, corrected-distance visual acuity at 1 to 6 months (weighted mean difference = -0.07 [95% confidence interval {CI} -0.10 to -0.03]; I2 = 0%; P < .001) after surgery was better and intraoperative Descemet membrane perforation occurred less often (odds ratio = 0.53 [95% CI 0.31-0.92]; I2 = 6%; P = .02) than in eyes treated with M-DALK. No clinically significant differences in other outcomes were found among the groups. CONCLUSIONS Both F-DALK and M-DALK are safe and efficacious for patients with keratoconus. Compared with M-DALK, F-DALK can provide better early visual acuity and reduce the intraoperative perforation rate, and its likely improvements to long-term visual quality and endothelial cell preservation warrant further investigation. In addition, the 2 techniques seem to be comparable regarding refractive outcomes and other complications.
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Affiliation(s)
- Kaiyue Du
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Enshuo Liu
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Nan Li
- Peking University Third Hospital (N.L.), Beijing, China
| | - Bowei Yuan
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Rongmei Peng
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Jing Hong
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China.
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Deshmukh R, Stevenson LJ, Vajpayee RB. Laser-assisted corneal transplantation surgery. Surv Ophthalmol 2021; 66:826-837. [PMID: 33524460 DOI: 10.1016/j.survophthal.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/01/2022]
Abstract
Corneal transplant surgeries have a broad range of indications with outcomes largely dependent on surgeon experience. Traditional manual techniques have certain limitations pertaining to the preparation of donor tissue and the recipient bed that might affect the predictability of visual outcomes. Use of lasers for keratoplasty procedures not only improves the repeatability and consistency of the technique, but also enables the surgeon to control the thickness and shape of the transplant tissue tailored to the specific condition. Despite the advantages, cost-effectiveness and technical know-how remain the major challenges. We discuss the various techniques of laser-assisted keratoplasties with respect to their methods, precision, and efficacy in various corneal indications.
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Affiliation(s)
- Rashmi Deshmukh
- Division of Ophthalmology and Visual Sciences, Eye ENT Centre, Queens Medical Centre, University of Nottingham, UK.
| | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Femtosecond-Laser Assisted Surgery of the Eye: Overview and Impact of the Low-Energy Concept. MICROMACHINES 2021; 12:mi12020122. [PMID: 33498878 PMCID: PMC7912418 DOI: 10.3390/mi12020122] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022]
Abstract
This article provides an overview of both established and innovative applications of femtosecond (fs)-laser-assisted surgical techniques in ophthalmology. Fs-laser technology is unique because it allows cutting tissue at very high precision inside the eye. Fs lasers are mainly used for surgery of the human cornea and lens. New areas of application in ophthalmology are on the horizon. The latest improvement is the high pulse frequency, low-energy concept; by enlarging the numerical aperture of the focusing optics, the pulse energy threshold for optical breakdown decreases, and cutting with practically no side effects is enabled.
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Sahay P, Stevenson LJ, Agarwal T, Sharma B, Sharma N, Vajpayee RB. Shaped corneal transplantation surgery. Br J Ophthalmol 2020; 105:9-16. [PMID: 32217546 DOI: 10.1136/bjophthalmol-2019-315754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/22/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
Since its inception in 1905, keratoplasty techniques have continuously evolved. Shaped keratoplasty procedures have allowed corneal surgeons to use complex graft-host junctions and non-circular graft designs to optimise wound strength and healing, facilitate early suture removal and expedite visual rehabilitation. While this was initially limited to penetrating procedures, shaped lamellar keratoplasty techniques have since emerged. Furthermore, the arrival of femtosecond laser has dramatically increased the range of graft designs available to surgeons, due to the technology's ability to precisely cut complex wound edges. This review describes the broad range of shaped keratoplasty grafts currently available and elaborates on their respective advantages and disadvantages in relation to conventional keratoplasty.
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Affiliation(s)
- Pranita Sahay
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tushar Agarwal
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Namrata Sharma
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia .,University of Melbourne, Parkville, Victoria, Australia.,Vision Eye Institute, Melbourne, Victoria, Australia
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Boden KT, Schlosser R, Boden K, Januschowski K, Szurman P, Rickmann A. Novel Liquid Interface for Femtosecond Laser-Assisted Penetrating Keratoplasty. Curr Eye Res 2020; 45:1051-1057. [DOI: 10.1080/02713683.2020.1716985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Katrin Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Kai Januschowski
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Centre for Ophthalmology, University Eye Hospital Tuebingen, Tuebingen, Germany
| | - Peter Szurman
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Centre for Ophthalmology, University Eye Hospital Tuebingen, Tuebingen, Germany
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Abstract
PURPOSE To report long-term visual and astigmatism outcomes in cases of zig-zag femtosecond laser-enabled penetrating keratoplasty (FLEK). METHODS Retrospective review. Three hundred thirty-five eyes of 287 patients underwent (FLEK) with a zig-zag incision pattern. Patients were assessed preoperatively and underwent postoperative comprehensive examinations at standard intervals of 1, 3, 6, 9, and 12 months, and 6 months thereafter. Postoperative uncorrected distance visual acuity and spectacle-corrected distance visual acuity and manifest and topographical (Mrx cyl and Topo cyl) astigmatism were compared with preoperative values. RESULTS Three hundred thirty-five eyes received FLEK with zig-zag configuration. Data are presented for the last recorded visit before any refractive procedure. Sutures were removed in 202 of 335 eyes at an average time to removal of 1.3 ± 1.1 years, and a mean follow-up period of 2.9 ± 2.1 years (range 0-10 years). After full suture removal, mean uncorrected distance visual acuity and spectacle-corrected distance visual acuity were logarithm of the minimum angle of resolution 0.84 (Snellen 20/138) ± 0.55 and 0.33 (Snellen 20/42) ± 0.33, respectively. Mean Mrx cyl and Topo cyl of these groups were 3.38 ± 2.22 and 4.77 ± 3.15, respectively. Of the total number of grafts, the rate of graft rejections was 14.0%, and the failure rate was 5.6%. CONCLUSIONS The femtosecond laser-generated zig-zag-shaped incision results in lower manifest and topographical astigmatism than the reported average for conventional penetrating keratoplasty. Graft rejection and failure rates are similar to published data for conventional penetrating keratoplasty.
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Reconsidering Sequential Double Running Suture Removal After Penetrating Keratoplasty: A Prospective Randomized Study Comparing Excimer Laser and Motor Trephination. Cornea 2017; 37:301-306. [DOI: 10.1097/ico.0000000000001420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Espandar L, Mandell JB, Niknam S. Femtosecond laser-assisted decagonal deep anterior lamellar keratoplasty. Can J Ophthalmol 2016; 51:67-70. [DOI: 10.1016/j.jcjo.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 12/05/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
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Comparison of Long-Term Outcomes of Femtosecond Laser-Assisted Keratoplasty with Conventional Keratoplasty. Cornea 2016; 35:293-8. [DOI: 10.1097/ico.0000000000000739] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls. J Ophthalmol 2015; 2015:645830. [PMID: 26483974 PMCID: PMC4592921 DOI: 10.1155/2015/645830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/02/2015] [Accepted: 05/13/2015] [Indexed: 11/18/2022] Open
Abstract
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.
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A new technology for applanation free corneal trephination: the picosecond infrared laser (PIRL). PLoS One 2015; 10:e0120944. [PMID: 25781907 PMCID: PMC4363595 DOI: 10.1371/journal.pone.0120944] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/29/2015] [Indexed: 11/19/2022] Open
Abstract
The impact of using a Femtosecond laser on final functional results of penetrating keratoplasty is low. The corneal incisions presented here result from laser ablations with ultrafast desorption by impulsive vibrational excitation (DIVE). The results of the current study are based on the first proof-of-principle experiments using a mobile, newly introduced picosecond infrared laser system, and indicate that wavelengths in the mid-infrared range centered at 3 μm are efficient for obtaining applanation-free deep cuts on porcine corneas.
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Clinical backgrounds of postoperative keratoplasty patients with spontaneous wound dehiscence or gaps after suture removal. Cornea 2014; 33:1320-3. [PMID: 25343700 DOI: 10.1097/ico.0000000000000284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report that spontaneous postkeratoplasty wound dehiscence or gaps caused by suture removal may occur years after penetrating and deep lamellar keratoplasty. METHODS We retrospectively reviewed the medical records of 667 keratoplasty patients (890 eyes). This study included 8 eyes of 8 patients (3 men and 5 women) aged 64 to 86 years who suffered from spontaneous wound dehiscence or gaps caused by suture removal. We examined their clinical backgrounds such as surgical procedure, reason for suture removal, and time interval between keratoplasty and suture removal. RESULTS The surgical procedures included 6 penetrating keratoplasties and 2 deep anterior lamellar keratoplasties. The most common reason for suture removal was high corneal astigmatism. Time interval between keratoplasty and suture removal was 15.9 ± 7.7 months (7-26 months). Three patients underwent suture removal from 6 months to 1 year after keratoplasty, 3 patients from 1 to 2 years, and 2 patients after more than 2 years. CONCLUSIONS Whenever postoperative keratoplasty suture is removed, it is important to consider that wound dehiscence or gaps may occur without incidence of trauma.
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Canovetti A, Malandrini A, Lenzetti I, Rossi F, Pini R, Menabuoni L. Laser-assisted penetrating keratoplasty: 1-year results in patients using a laser-welded anvil-profiled graft. Am J Ophthalmol 2014; 158:664-670.e2. [PMID: 25036878 DOI: 10.1016/j.ajo.2014.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/23/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe a new laser-assisted penetrating keratoplasty technique combining a femtosecond anvil-like trephination pattern with the laser welding procedure. DESIGN Cohort prospective study with 1 year of follow-up (June 2011 through January 2013). METHODS This study was performed at Misericordia e Dolce Public Hospital, Prato, Italy. Twenty-four eyes of 22 patients underwent penetrating keratoplasty: 4 had granular dystrophy, 12 had keratoconus in its final stages, 3 had post-herpetic leukoma, and 5 had corneal scars. A femtosecond laser was used to create anvil-profiled cuts in donor and recipient corneas. Diode laser welding was performed, supporting standard suturing. All patients were evaluated for corrected distance visual acuity, pachymetry, manifest astigmatism, and endothelial cell density after 1, 3, 6, and 12 months. RESULTS Mean ± standard deviation postoperative corrected visual acuity was 0.48 ± 0.23 logarithm of the minimal angle of resolution (logMAR), 0.30 ± 0.18 logMAR, 0.18 ± 0.13 logMAR, and 0.13 ± 0.16 logMAR at 1, 3, 6, and 12 months, respectively. At the same follow-up times, mean pachymetry was 537 ± 57 μm, 533 ± 74 μm, 528 ± 72 μm, and 529 ± 58 μm, respectively; and mean endothelial cell density was 1945 ± 371 cells/mm(2), 1881 ± 410 cells/mm(2), 1781 ± 401 cells/mm(2), and 1730 ± 376 cells/mm(2), respectively. Mean manifest and topographic postoperative astigmatism were: 3.6 ± 2.5 diopters (D) and 4.65 ± 2.57 D at 1 month, 2.93 ± 2.34 D and 4.79 ± 2.85 D at 3 months, 2.82 ± 1.75 D and 3.44 ± 2.28 D at 6 months, and 2.08 ± 1.25 D and 2.73 ± 2.01 D at 12 months, respectively. All surgical operations were successful and without intraoperative complications. CONCLUSIONS The use of the anvil trephination profile was effective for performing laser-assisted penetrating keratoplasty. The large donor-recipient interface enables the laser welding procedure and good preservation of the recipient's endothelial cell pool.
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Kopani KR, Page MA, Holiman J, Parodi A, Iliakis B, Chamberlain W. Femtosecond laser-assisted keratoplasty: full and partial-thickness cut wound strength and endothelial cell loss across a variety of wound patterns. Br J Ophthalmol 2014; 98:894-9. [PMID: 24648419 DOI: 10.1136/bjophthalmol-2013-304546] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate wound strength for patient safety during transport and endothelial viability when partial and complete femtosecond laser-assisted keratoplasty (FLAK) incisions are made in cadaveric corneas. METHODS 19 human corneoscleral rims were divided into six groups, mounted on an anterior chamber maintainer and cut with a femtosecond laser programmed to the following patterns: 'zigzag' (A), 'mushroom' (B) and 'top hat' (C) in both full (1) and partial (2) thicknesses. The pressure required to produce leakage from the corneal incision was then measured. Eight additional corneas were cut with the 'zigzag' pattern: four full and four partial thickness, prepared and transported per standard eye bank protocol, and analysed for endothelial cell loss with trypan blue staining and digital image analysis. RESULTS Mean leakage pressure in mm Hg for group A1 was 110 (SD 94); group A2, 1180 (SD 468); group B1, 978 (SD 445); group B2, 987 (SD 576); group C1, 710 (SD 474); group C2, 1290 (SD 231). There was a significant difference in leakage pressure between groups A1 and A2 (p=0.05), groups A1 and B1 (p=0.05), and groups A1 and C1 (p=0.05). Mean percentage endothelial damage after full-thickness cuts was 8.40 (SD 2.34) and 5.30 (SD 1.33) in partial-thickness cuts (p=0.11). CONCLUSIONS Partial thickness zigzag, top hat and mushroom-style partial FLAK incisions left an intact tissue wall with high resistance to rupture, whereas full-thickness cuts were more variable. Laser trephination and eye bank handling protocol for donor FLAK buttons leads to moderate peripheral endothelial cell loss in tissue with both complete and partial cuts.
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Chew ACY, Mehta JS, Tan DTH. One Year of Cornea Research in Review-2012. Asia Pac J Ophthalmol (Phila) 2013; 2:401-13. [PMID: 26107152 DOI: 10.1097/apo.0000000000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to provide an update of significant cornea literature published in the past 1 year. DESIGN This was a literature review. METHODS The authors conducted a 1-year English-language literature search on PubMed, from January 1, 2012, to December 31, 2012, using the following terms: corneal transplantation, anterior lamellar keratoplasty, penetrating keratoplasty, endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, Descemet membrane endothelial transfer, ocular surface epithelial transplantation, limbal epithelial transplantation, cultivated oral mucosal epithelial transplantation, keratoprosthesis, infectious keratitis, cross-linking, keratoconus, corneal neovascularization, corneal imaging, optical coherence tomography, Pentacam Scheimpflug imaging, and in vivo confocal microscopy. RESULTS This review includes original articles and review articles that contain significant updates and novel aspects in the field of cornea from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Ophthalmology, Investigative Ophthalmology and Visual Science, and Cornea. Letters to the editor, unpublished work, manuscripts not in English, and abstracts were not included. CONCLUSIONS This review highlights significant literature that is applicable to the practicing ophthalmologist.
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Affiliation(s)
- Annabel C Y Chew
- From the *Singapore National Eye Centre, †Singapore Eye Research Institute, ‡Duke-NUS Graduate Medical School, and §Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Menabuoni L, Canovetti A, Rossi F, Malandrini A, Lenzetti I, Pini R. The 'anvil' profile in femtosecond laser-assisted penetrating keratoplasty. Acta Ophthalmol 2013; 91:e494-5. [PMID: 23617376 DOI: 10.1111/aos.12144] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Birnbaum F, Wiggermann A, Maier PC, Böhringer D, Reinhard T. Clinical results of 123 femtosecond laser-assisted penetrating keratoplasties. Graefes Arch Clin Exp Ophthalmol 2012; 251:95-103. [PMID: 22573413 DOI: 10.1007/s00417-012-2054-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/01/2012] [Accepted: 04/23/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Postoperative astigmatism following penetrating keratoplasty is a major problem after corneal transplantation. The main goal of new trephination techniques such as femtosecond laser or excimer-laser trephination is to improve refractive and visual outcomes. The femtosecond laser technique makes profiled corneal trephinations such as the top hat or mushroom profile possible. We present the postoperative outcome of femtosecond laser-assisted penetrating keratoplasties. METHODS We performed 123 femtosecond laser-assisted penetrating keratoplasties in 119 patients. The main outcome measures were intraoperative specifics, astigmatism, and irregularity in Orbscan corneal topography, as well as the occurrence of immune reactions and side-effects. RESULTS All sutures have been removed in 49 of these 123 eyes. Their mean follow-up was 13.9 ± 4.5 months. Time to complete suture removal (n = 49) was 12.0 ± 3.7 months in the mushroom group and 9.8 ± 2.1 months in the top hat group. Mean astigmatism in Orbscan topography was 6.4 ± 3.0 diopters in the mushroom and 5.8 ± 4.6 diopters in the top hat group (all sutures out). CONCLUSIONS Femtosecond laser-assisted penetrating keratoplasty is a safe surgical technique. Due to the steps in profiled trephinations, the wound area is larger and theoretically the wound healing is, thus, faster and more stable. Complete suture removal is possible at an earlier time point compared to conventional penetrating keratoplasty. However, refractive results are not superior to those following conventional trephination.
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Affiliation(s)
- Florian Birnbaum
- Eye Hospital, Klinikum Bremen-Mitte gGmbH, St.-Jürgenstr. 1, 28177 Bremen, Germany.
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