Research Article
Volume 11 Issue 6 - 2020
Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Technique and Results
Malyugin B, Pashtaev A* and Izmailova S
FGAU "MNTK" Eye Microsurgery" Named. Acad. S.N. Fedorova, Ministry of Health of the Russian Federation, Russia
*Corresponding Author: Pashtaev A, FGAU "MNTK" Eye Microsurgery" Named. Acad. S.N. Fedorova, Ministry of Health of the Russian Federation, Russia.
Received: March 16, 2020; Published: May 12, 2020


Purpose: To analyze and compare the results of treating keratoconus by femtosecond laser-assisted deep anterior lamellar keratoplasty with optimized cutting algorithm (FS-DALK) with traditional deep anterior lamellar keratoplasty (DALK).

Methods: It was a randomized prospective study with parallel control. An original technique of FS-DALK with optimized cutting algorithm (AMO IntraLase 60 kHz) allowing to result “mushroom-shape” transplant and recipient’s bed edge and avoid using sharp instruments for making big-bubble, was developed. FS-DALK was performed for 34 keratoconic eyes (main group). Control group was compiled of 35 keratoconic eyes, treated by deep anterior lamellar keratoplasty (DALK). The 2 groups were compared in terms of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), postoperative astigmatism, endothelial cell loss, central graft thickness and residual recipient’s tissue thickness. Also, corneal hysteresis (CH) and corneal resistance factor (CFR) were evaluated before and after surgery in the main group.

Results: At 6 months observation UCVA was 0.21 ± 0.17 and 0.12 ± 0.13 (p = 0.031), BSCVA was 0.54 ± 0.15, and 0.42 ± 0.14 (p = 0.023) in main and control group, respectively. At 12 months observation UCVA was 0.29 ± 0.19 and 0.26 ± 0.2 (p > 0.05), BSCVA was 0.66 ± 0.15 and 0.54 ± 0.18 (p > 0.05) in main and control group, respectively. Part of patients achieved BSCVA equal or higher than 0.5 was 97.1% in the main group and 71.4% in the control one (p = 0.013). Postoperative astigmatism at 12 months observation was equal to 3.7 ± 1.4 dioptres in the main group and was higher (p = 0.04) in the control one (4.8 ± 1.9 dioptres). Endothelial cell loss (7.4 and 6.1%, p > 0.05), central graft thickness (506 ± 20 and 521 ± 28 um, p > 0.05) and residual recipient’s tissue thickness (25 ± 4 and 25 ± 5 um, p > 0.05) were comparable in 2 groups. CH and CRF had improved from 6.6 ± 1 and 4.8 ± 1.1 mm Hg, preoperatively, to 9.9 ± 0.7 and 9.3 ± 0.8 mm Hg (p < 0.001) at 1-year observation in the main group.

Conclusion: Introducing FS-DALK with optimized cutting algorithm resulted in faster visual recovery, lesser postoperative astigmatism and lager part of patients, achieved BSCVA equal or higher than 0.5. The method also showed improving CH and CRF.

Keywords: Keratoconus; Femtosecond Laser; Deep Anterior Lamellar Keratoplasty; Femto-Keratoplasty; Big-Bubble Technique


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Citation: Pashtaev A., et al. “Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Technique and Results”. EC Ophthalmology 11.6 (2020): 11-18.

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