Comparison Between Manual Deep Anterior Lamellar Keratoplasty and the Automated Technique With Femtosecond Laser Associated With Phototherapeutic Keratectomy by Excimer Laser in Keratoconus

Abstract

Purpose: : to compare the efficacy of deep anterior lamellar keratoplasty (DALK) by femtosecond laser associated with phototherapeutic keratectomy versus big-bubble associated with femtosecond laser in patients with keratoconus.

Methods: : ramdomized, controlled, prospective study of 24 patients divided into 2 groups. Group 1: DALK by femtosecond laser associated with phototherapeutic keratectomy; group 2: DALK by big-bubble technique associated with femtosecond laser. In the post operatory, patients will be avaliated by best spectacle corrected visual acuity (BSCVA), confocal microscopy (CM) and anterior segment optical coherence tomography (OCT Visante^TM).

Results: : BSCVA in the third postoperative month in group 1 and 2 were 0,85 logMAR and 0,3 logMAR, respectively. CM in both groups showed normal epithelial layer, hiperreflectivity in keratocites and endothelial cells without abnormalities. In group 1, CM showed irregularity in the interface. Residual stromal paquimetry of group 1 and 2 by OCT Visante^TM were, respectively, 218,6 µm (varying from 154,8 to 303,6 µm) and 59,4 µm (varying from 46,7 to 72,5 µm).

Conclusions: : initial results suggest that DALK by big-bubble associated with femtosecond laser is more efficient than DALK by femtosecond laser associated with phototherapeutic keratectomy in keratoconus.

Clinical Trial: : www.unifesp.br

Keywords: transplantation • keratoconus • visual acuity