Transcript Femtosecond Laser–Assisted Sutureless Anterior Lamellar

Femtosecond Laser–Assisted Sutureless
Anterior Lamellar Keratoplasty
Einollahi MD
Shahid behshti ophthalmic excellence
www.iranophthalex.com
Anterior LK provides several advantages over conventional
full-thickness keratoplasty
• Minimizes potential intraoperative Complications
• Faster visual and refractive recovery
• Maintaining the recipient endothelial layer
decreases the rate of graft rejection
• perform multiple lamellar (anterior, stromal,
posterior– endothelial) corneal transplantations
from one donor’s cornea
Anterior lamellar kerato plasty (ALK)
Is a partial-thickness corneal transplantation
used in eyes with pathology limited to the
anterior layers
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Superficial corneal scars after
Trauma
keratitis
epithelial/ anterior stromal dystrophies
Anterior stromal dystrophies
The major limitations with anterior
LK are the technical challenges
• Difficult to performing manual dissections
• The resulting stromal interface irregularities
between the donor and recipient interface
• stromal interface haze
• Induced irregular astigmatism
• Loss of (BCVA)
Recent procedure to minimize ALK
difficulties
• The improvements in automated micro keratomes
and artificial anterior chambers (ALTK)
• Femtosecond Laser–Assisted Sutureless Anterior
Lamellar Keratoplasty
Sutureless femtosecond Laser–Assisted
Anterior Lamellar Keratoplasty(FALK)
• Highly reproducible dimensions of the cuts at
the graft– host junction
• Accurate the shape and corneal dimensions
of the donor and recipient
• safe
• Efficient
Sutureless FALK
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The high precision and reproducibility of femtosecond
A smoother donor– host interface
Less induced Irregular astigmatism and Interface haze
Faster and better wound healing, without the need for
sutures
• Excimer laser in the PTK mode successfully treat
superficial corneal opacities or refractory error in Bed
The main advantages of femtosecond laser over mechanical
microkeratome are
• Reduced incidence of flap complications
• Greater surgeon choice of flap diameter and
thickness, side cut angle, hinge position, and length
• A more regular corneal surface
• can create flaps as thin as 90 mm
FALK superior than PTK
Sutureless FALK Surgical Technique
• Performed Anterior segment ocular coherence
tomography OCT before surgery
• Performed under topical anesthesia
• Create the donor graft with femtosecond
Laser from donor globe
Corneal OCT
Sutureless FALK Surgical Technique…
• The lenticule adjusted in relation to depth of
the lesions according to the anterior segment
OCT findings
• Depending on the donor tissue quality and
edema, additional thickness was added to
the donor lenticule to adjust for donor tissue
swelling
• A recipient corneal lenticule was created using
similar femtosecond laser or 0.1 mm smaller
Sutureless FALK Surgical Technique
• After the procedure, the patient was transferred to
the surgery room, where the corneal button was
removed with a blunt spatula leaving the clear
stromal residual bed
• The keratectomy incision was dried with
methylcellulose sponges
• After approximately 5 minutes (to dehydrate the
cornea and improve adhesion
• A bandage contact lens was fitted over the cornea
Post operation
• Patients were then placed on a topical
antibiotic and steroid for 1 week, and steroid
drops were slowly tapered over several
months
• A bandage contact lens removed over the
cornea after 2 weeks
Sutureless FALK Surgical Technique
• Femtosecond laser energy adjustments should
be considered
• Patients with severe corneal scars totally
obscuring visualization of anterior segment
structures were excluded because of concern
that the scars’ opacification could scatter
laser energy
Complications
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Residual corneal scarring
Residual deposits
Anisometropia
Dry eye
Graft dislocation
graft rejection
Infection
Epithelial ingrowth
Epithelial ingrowth
Suture less FALK Surgical Technique
Suture less FALK Surgical Technique
Pre OP
Post OP