Abstract
Purpose::
To evaluate the safety and the effectiveness of the deep anterior lamellar keratoplasty performed with Intralase® femtosecond laser (femtoDALK).
Methods::
Five eyes of five patients affected by keratoconus, were submitted to deep anterior lamellar keratoplasty using a femtosecond laser. Preoperatively , mean pachimetry was 392.8 +/- 53.9SD, and mean corneal power was 52.2 +/- 1,2SD; mean UCVA was 0.2 +/- 1.3SD, and mean BSCVA was 0.33 +/- 0.21SD. The surgical technique was performed planning the maximum deepness reliable with Intralase to cut the stroma, leaving at least 100 µm, and completing the receiving bed with a +2sf PRK followed by a 40-60µm PTK ablation with an excimer laser (Technolas 217C, Baush & Lomb, USA) to reach the predescemetic plane. Then, after Descemet/endothelium layer stripping, a corneal donor button (increased in diameter of 0.25mm) was sutured in place with 16 single sutures in nylon 10/0.
Results::
In one case, during the first step, performing the stromal cut with Intralase, a perforation was found requiring a penetrating keratoplasty. In the other four cases, the procedure was carried out without any intraoperative complication, and a clear graft was found from the first week after surgery. Three months after surgery, mean UCVA resulted 0.30 +/- 1.8SD with a mean BSCVA of 0.60 +/- 0.14SD. Evaluation with a confocal microscopy (Confoscan4, Nidek technologies, Tokyo, Japan) showed no differences in pre and postoperative endothelial pattern and density in all cases treated.
Conclusions::
Basing on the preliminary results obtained, this personal surgery technique of deep anterior lamellar keratoplasty seems to be safe and effective. Greater follow-up is needed to confirm our preliminary results.
Keywords: keratoconus • laser • transplantation