Femtosecond Laser Shaped Penetrating Keratoplasty: One-year Results Utilizing a Top-hat Configuration

• Published in: American journal of ophthalmology 2008-02, Vol.145 (2), p.210-214.e2
• Main Authors: Price, Francis W, Price, Marianne O
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cell Count; Cornea - surgery; Corneal Diseases - surgery; Endothelium, Corneal - pathology; Female; Health Insurance Portability & Accountability Act 1996-US; Humans; Intraoperative Complications; Keratoplasty, Penetrating - methods; Laser Therapy - methods; Lasers; Male; Medical sciences; Miscellaneous; Ophthalmology; Patients; Postoperative Complications; Prospective Studies; Refraction, Ocular - physiology; Surgery; Suture Techniques; Transplants & implants; Treatment Outcome; Visual Acuity - physiology; Wound Healing
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2007.09.026

Purpose To evaluate use of a femtosecond laser to create shaped corneal grafts in penetrating keratoplasty (PK) in treatment of corneal disease. Design Prospective, nonrandomized clinical study. Methods Six eyes of six patients were treated in this initial series. Two had herpetic scarring, two had pseudophakic bullous keratopathy, one had Fuchs endothelial dystrophy and one had endothelial dystrophy with a corneal scar. Preoperative best spectacle-corrected visual acuity (BSCVA) ranged from count fingers to 20/50. Donor and recipient corneas were cut in a “top-hat” shaped configuration utilizing a 15-kHz femtosecond laser. Results All eyes were successfully treated without intraoperative complications. Mean time to complete suture removal was 7.0 ± 1.9 months (range, 4.1 to 9.7 months). At the one-year postoperative exam, mean endothelial cell density was 2030 ± 600 cells/mm2 (range, 1007 to 2497 cells/mm2 ), which was comparable with cell density measured in a prior series of traditional PKs ( P = .21). BSCVA ranged from 20/400 to 20/25. In two eyes, preexisting retinal conditions limited visual improvement following transplantation. Conclusions Use of the femtosecond laser allowed precise dissection of donor and recipient corneas even when significant opacities were present. The use of a top-hat configuration allowed for an increased area of wound healing in these eyes.