Abstract
Purpose: :
To describe the visual and anatomic outcomes of patterned corneal grafts after femtosecond-laser assisted keratoplasty (FLAK).
Methods: :
Six eyes of six patients were prospectively enrolled in a trial to evaluate outcomes after femtosecond-laser assisted penetrating keratoplasty. Mushroom and top-hat patterns was used. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, corneal topography, and endothelial cell density were measured preoperatively, and 1, 3, and 6 months postoperatively. Clinical confocal microscopy and anterior segment optical coherence tomography (OCT) were used to assess wound healing.
Results: :
Three month follow up of six eyes revealed significant improvement in UCVA from 20/200 to 20/50 (p=0.006) and positive trend in BSCVA from 20/50 to 20/30 (p=0.18). The endothelial cell density ranged between 1256 to 3291 cells/mm2 (mean 2415 ± 829 cells/mm2) three months postoperatively with a cell loss average of 22.19%. Preoperative and 3 month postoperative spherical equivalents were -7.90D and -3.04D, respectively (p=0.02). Six month follow up of four eyes also revealed significant improvement in UCVA from 20/200 to 20/60 (p=0.03) and a positive trend in BSCVA from 20/50 to 20/30 (p=0.14). The endothelial cell density at 6 months post surgery, ranged between 1051 to 3135 cells/mm2 (mean of 2004 ± 1030 cells/mm2) with an average cell loss of 33.63%. Preoperative and 6 month postoperative spherical equivalents were -7.90D and -3.70D, respectively. Assessment of wound healing at the graft host junction by OCT found that FLAK grafts were well positioned, with anterior and posterior graft-host mismatch decreasing over 6 months. Clinical confocal biomicroscopy revealed keratocyte activation postoperatively in all cases, primarily in the anterior stroma. Keratocyte activation diminished over 6 months. Needle-like opacities were observed by confocal biomicroscopy, primarily within the anterior stroma, with increased frequency in the periphery as compared to the central cornea.
Conclusions: :
Preliminary results describe femtosecond laser assisted keratoplasty with patterned corneal grafting as a safe and effective method for corneal transplantation. This technique offers well interposed graft-host interface and early wound healing.
Clinical Trial: :
www.clinicaltrials.gov HUM 15615-FLAK
Keywords: transplantation • laser • cornea: stroma and keratocytes