Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK).
Big bubble
Corneal endothelium
Deep anterior lamellar keratoplasty
Femtosecond laser
Keratoconus
Journal
Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
ISSN: 1435-702X
Titre abrégé: Graefes Arch Clin Exp Ophthalmol
Pays: Germany
ID NLM: 8205248
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
15
03
2022
accepted:
09
07
2022
revised:
30
06
2022
pubmed:
28
7
2022
medline:
4
1
2023
entrez:
27
7
2022
Statut:
ppublish
Résumé
The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet's membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography. A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group). In the full FS-DALK group, the BB's formation was significantly higher (64.3% vs. 36.4%, p = 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min, p = 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%, p = 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%, p < 0.001 for both comparisons). Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time.
Identifiants
pubmed: 35896678
doi: 10.1007/s00417-022-05765-9
pii: 10.1007/s00417-022-05765-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
185-191Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Males JJ, Viswanathan D (2018) Comparative study of long-term outcomes of accelerated and conventional collagen crosslinking for progressive keratoconus. Eye 32:32–38. https://doi.org/10.1038/eye.2017.296
doi: 10.1038/eye.2017.296
Henein C, Nanavaty MA (2017) Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye 40:3–14. https://doi.org/10.1016/j.clae.2016.10.001
doi: 10.1016/j.clae.2016.10.001
Keane M, Coster D, Ziaei M, Williams K (2014) Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus. Cochrane Database Syst Rev:CD009700. https://doi.org/10.1002/14651858.CD009700.pub2
Alio JL, Abdelghany AA, Barraquer R et al (2015) Femtosecond laser assisted deep anterior lamellar keratoplasty outcomes and healing patterns compared to manual technique. Biomed Res Int 2015:397891. https://doi.org/10.1155/2015/397891
doi: 10.1155/2015/397891
Anwar M, Teichmann KD (2002) Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 28:398–403. https://doi.org/10.1016/s0886-3350(01)01181-6
doi: 10.1016/s0886-3350(01)01181-6
Pasricha ND, Shieh C, Carrasco-Zevallos OM et al (2016) Needle depth and big-bubble success in deep anterior lamellar keratoplasty: an ex vivo microscope-integrated OCT study. Cornea 35:1471–1477. https://doi.org/10.1097/ICO.0000000000000948
doi: 10.1097/ICO.0000000000000948
Santorum P, Yu AC, Bertelli E, Busin M (2022) Microscope-integrated intraoperative optical coherence tomography-guided big-bubble deep anterior lamellar keratoplasty. Cornea 41:125–129. https://doi.org/10.1097/ICO.0000000000002826
doi: 10.1097/ICO.0000000000002826
Naderan M, Shoar S, Kamaleddin MA et al (2015) Keratoconus clinical findings according to different classifications. Cornea 34:1005–1011. https://doi.org/10.1097/ICO.0000000000000537
doi: 10.1097/ICO.0000000000000537
Liu Z, Pflugfelder SC (1999) Corneal surface regularity and the effect of artificial tears in aqueous tear deficiency. Ophthalmology 106:939–943. https://doi.org/10.1016/S0161-6420(99)00513-8
doi: 10.1016/S0161-6420(99)00513-8
Huang OS, Htoon HM, Chan AM et al (2019) Incidence and outcomes of intraoperative Descemet membrane perforations during deep anterior lamellar keratoplasty. Am J Ophthalmol 199:9–18. https://doi.org/10.1016/j.ajo.2018.10.026
doi: 10.1016/j.ajo.2018.10.026
Gadhvi KA, Romano V, Fernández-Vega Cueto L et al (2019) Deep anterior lamellar keratoplasty for keratoconus: multisurgeon results. Am J Ophthalmol 201:54–62. https://doi.org/10.1016/j.ajo.2019.01.022
doi: 10.1016/j.ajo.2019.01.022
Buzzonetti L, Petrocelli G, Valente P (2012) Femtosecond laser and big-bubble deep anterior lamellar keratoplasty: a new chance. J Ophthalmol 2012:264590. https://doi.org/10.1155/2012/264590
doi: 10.1155/2012/264590
de Macedo JP, de Oliveira LA, Hirai F, de Sousa LB (2018) Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus. Int J Ophthalmol 11:807–812. https://doi.org/10.18240/ijo.2018.05.15
doi: 10.18240/ijo.2018.05.15
Achiron A, Haddad F, Gerra M et al (2016) Predicting cataract surgery time based on preoperative risk assessment. Eur J Ophthalmol 26:226–229. https://doi.org/10.5301/ejo.5000697
doi: 10.5301/ejo.5000697
Liu Y-C, Wittwer VV, Yusoff NZM et al (2019) Intraoperative optical coherence tomography-guided femtosecond laser-assisted deep anterior lamellar keratoplasty. Cornea 38:648–653. https://doi.org/10.1097/ICO.0000000000001851
doi: 10.1097/ICO.0000000000001851
Han DCY, Mehta JS, Por YM et al (2009) Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol 148:744-751.e1. https://doi.org/10.1016/j.ajo.2009.05.028
doi: 10.1016/j.ajo.2009.05.028
Khattak A, Nakhli FR, Al-Arfaj KM, Cheema AA (2018) Comparison of outcomes and complications of deep anterior lamellar keratoplasty and penetrating keratoplasty performed in a large group of patients with keratoconus. Int Ophthalmol 38:985–992. https://doi.org/10.1007/s10792-017-0548-9
doi: 10.1007/s10792-017-0548-9