Сравнительный анализ клинико-функциональных результатов задней послойной кератопластики с использованием фемтосекундного лазера и микрокератома

Abstract

Purpose. To compare the clinical and functional outcomes of posterior lamellar keratoplasty using the femtosecond laser (FS-DSEK) and manual microkeratome (DSAEK) for graft preparation. Material and methods . The prospective single-center randomized study included 38 patients (39 eyes) with simultaneous Fuchs endothelial dystrophy and cataract. There were enrolled in the study group 19 patients (19 eyes) following FS-DSEK combined with phacoemulsification and IOL implantation. The control group included 19 patients (20 eyes) following microkeratome-assisted DSAEK combined with phacoemulsification and IOL implantation. Pre- and post-operatively the standard and special diagnostic methods were used (optical coherence tomography, confocal immersion microscopy, keratopachymetry, endothelial microscopy). Evaluation of transplant geometry was performed using the ratio between central and peripheral graft thickness (C:P ratio). The maximum follow­up period was 1 year. Results. In the study group the corneas were transparent in 89.5% of cases and 95% in the control group. At long-term follow-up periods (6 months and more) postoperatively there were no significant difference of UCVA and BCVA between groups (p>0.05). In the study and control group the median C:P ratio were 0.88 (0.85; 0.95) and 0.55 (0.48; 0.68), respectively (p<0.001). The mean hyperopic shifts in the study group were 27±0.9D and 1.25±0.81D in the control group (p=0.002). A correlation was revealed between hyperopic shift and C:P ratio of transplant, (r=- 0.406; p=0.019). Endothelial cell density loss at 12 months in the study group was higher in comparison to the control group and averaged 64.1±8.8% and 54.6±4.8%, respectively (p<0.001). Conclusion. Clinical and functional results in the early and long-term follow- up periods were comparable between both surgical techniques. The use of femtosecond laser in comparison to microkeratome-assisted DSAEK allows to obtain a more uniform graft creation in its thickness. We detected a correlation between the C:P ratio index and the development of hyperopic shift. For the first time the presence of a smaller hyperopic shift was confirmed (0.27±0.9D) in FS-DSEK compared with microkeratome- assisted DSAEK (1.25±0.81D).