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Luigi Mosca, Romina Fasciani, Luca Mosca, Laura Guccione, Emanuela Filomena Legrottaglie, Monica Riso, Emilio Balestrazzi; Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty: Two Years Follow-up. Invest. Ophthalmol. Vis. Sci. 2011;52(14):791.
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To report the long-lasting results of the technique of deep anterior lamellar keratoplasty assisted by a femtosecond laser (Femto-DALK).
19 eyes of 19 patients with keratoconus underwent deep anterior lamellar keratoplasty using a 60 kHz femtosecond laser for stromal cut (Femto-DALK). Mean preoperative pachometry was 361.19µm +/- 46.85SD; mean corneal power was 53.2D +/- 6.08SD; mean UCVA was 0.1 +/- 0.05SD, and mean BSCVA was 0.33 +/- 0.15SD; mean SE was 3.73D +/- 2.65SD; mean corneal topographic astigmatism was 4.3D +/- 2.82SD. Mean follow-up was 32.94 months +/- 11,50SD. The surgical technique involved the use of a 60 kHz femtosecond laser (IntraLase®, AMO, USA) to cut the stroma, leaving at least 100 µm. Then, to complete the receiving bed, a +3/4 sph refractive ablation followed by a 40-60µm PTK ablation with an excimer laser (Technolas 217C, Technolas Perfect Vision, Munchen, Germany) to reach as much as possible the predescemetic plane, was performed (basing on preoperative pachometry). Afterwards, a corneal donor button (increased in diameter of 0.25mm with respect to the stromal bed), after Descemet/endothelium layer stripping, was sutured in place with 16 single sutures, using 10/0 nylon
In two cases, during the first step, performing the stromal cut with the femtolaser, a perforation occurred requiring a penetrating keratoplasty (PK). In one case, a microperforation during the PTK ablation in the laser room was managed with air injection in anterior chamber and the procedure was completed with the corneal suture in the surgery room.
The femtolaser assisted DALK seems to be reproducible, safe and effective in keratoconic patients, but greater follow-up is needed to confirm our first results
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