Preliminary Results of a Novel Standardized Technique of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus.

Andrea Lucisano,Angeli Christy Yu,Laura Logozzo,Giuseppe Giannaccare,Giovanna Carnovale Scalzo,Federico Bernabei,Marco Pellegrini,Vincenzo Scorcia,Adriano Carnevali

doi:10.1155/2020/5496162

Abstract

Purpose To evaluate the feasibility and the initial outcomes of a novel standardized surgical technique of femtosecond laser- (FSL-) assisted big-bubble deep anterior lamellar keratoplasty (BBDALK) for eyes with keratoconus. Methods This prospective interventional case series included 11 consecutive FSL-assisted BBDALK procedures performed for the eyes with keratoconus from September 2019 to December 2019. The FSL was used to create (i) an intrastromal channel incision (1.7 mm in length, 4.6 mm in width, 80% depth, and cut energy of 1.70 μJ) and (ii) a 9.0 mm diameter circular lamellar side cut 65 μm above the endothelium (cut energy of 0.90 μJ) intersecting the intrastromal incision. In the operating room, a blunt dissector was used to open the intrastromal channel incision, through which a blunt spatula was inserted, tangentially advanced towards the center of the cornea, and replaced with a blunt cannula for pneumatic dissection. The subsequent surgical steps did not differ from the conventional technique. Main outcome measures were the success rate of pneumatic dissection and the percentage of intraoperative complications. Results Eleven eyes of 11 patients (6 males and 5 females; mean age: 34.54 ± 13.23 years) underwent FSL-assisted DALK. Using the FSL, both corneal incisions (lamellar side cut and intrastromal channel incision) were successfully created in all cases without the need for repeat docking or additional dissection. Pneumatic dissection with type 1 bubble formation succeeded in all 11 eyes (100%). DALK surgery was completed uneventfully in all cases. Descemet membrane perforation did not occur in any case, and no procedure was converted to penetrating keratoplasty. Conclusion Using standardized FSL parameters for both incision design and cut energy in BBDALK surgery, pneumatic dissection can be achieved in a very high rate of cases with minimal risk of intraoperative complications.

Highlights

Deep anterior lamellar keratoplasty (DALK) has been recognized as the first-line surgical procedure for eyes with corneal stromal disease but healthy endothelium [1, 2]. e main advantages of DALK over penetrating keratoplasty (PK) include the elimination of endothelial rejection, reduced endothelial cell loss, and improved long-term graft survival [3,4,5,6,7,8]
DALK has clear advantages over PK in terms of graft survival, technical challenges of the procedure along with poor reproducibility still limit its widespread adoption among corneal surgeons [21, 22]
We have demonstrated the feasibility of femtosecond laser- (FSL-)assisted BB-DALK according to our standardized technique

Summary

Introduction

Deep anterior lamellar keratoplasty (DALK) has been recognized as the first-line surgical procedure for eyes with corneal stromal disease but healthy endothelium [1, 2]. e main advantages of DALK over penetrating keratoplasty (PK) include the elimination of endothelial rejection, reduced endothelial cell loss, and improved long-term graft survival [3,4,5,6,7,8]. To evaluate the feasibility and the initial outcomes of a novel standardized surgical technique of femtosecond laser- (FSL-) assisted big-bubble deep anterior lamellar keratoplasty (BBDALK) for eyes with keratoconus. Using the FSL, both corneal incisions (lamellar side cut and intrastromal channel incision) were successfully created in all cases without the need for repeat docking or additional dissection.

Results

Conclusion