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Nicolas Rocher, Aurelien Hay, Jean-Marc Legeais, Antoine Rousseau, Nicolas Fayol, Gilles Renard, jean-louis bourges; Deep Anterior Lamellar Keratoplasty Performed With Femtosecond Laser. About 24 Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):789.
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to analyze functional et anatomical results of deep anterior lamellar keratoplasty performed with femtosecond laser (iDALK).
Retrospective monocentric study on consecutive cases operated on between 01/11/2008 and 01/08/2010. Both donnor and recipient were trephined using identical femtosecond laser cutting settings (60 kHz Intralase, AMO). The Descemet’s membrane (DM) was dissected either with the big-bubble technique or by peel-off. We analyzed the patient’s history, the leading cause indicating the procedure, the visual acuity, the astigmatism, the graft’s outcomes and the complications.
24 eyes of 24 patients (mean age : 34 years) were studied with 7 months of average follow-up (FU). The iDALK procédure was indicated for keratoconus, corneal scars or corneal dystrophies in respectively 82%,11% and 5% of the patients. Pre and postoperative Distant Corrected Visual Acuities (DCVA) were respectively 1,57 LogMAR and 0,45 LogMAR. The average astigmatism decreased from 6.0 D initially to 4.8 D at the end of the FU. All laser procedures were uneventful. The average delay for sutures removal was 7 months. The DALK had to be converted to PK in 3 patients after a giant DM’s tear occured (12%). The running suture slacken in one patient (4%). One abscess of the button and one persistent epithelial defect were also observed.
All final DCVA but one case increased compared to the initial DCVA. Despite the fact that the laser procedure is safe and reproducible, 10% DALK still need to be converted following peroperative perforations. The Zig-Zag cutting profile allows for a greater cicatrization area than any strait cut and therefore enable early suture removal. Preoperative and postoperative astigmatisms should carefully be analyzed on patients with highly pathologic recipient corneas. When assisted by femtoseconde laser, the deep anterior lamellar keratopasty (DALK) is a safe and reproducible procedure ensuring an optimal tectonic stability for the corneal graft.
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