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L. Mosca, R. Fasciani, L. Mosca, S. Di Landro, E. Mandarà, E. Balestrazzi; Deep Anterior Lamellar Keratoplasty Performed With Intralase® Femtosecond Laser for Keratoconus: Personal Surgical Technique. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4678.
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To evaluate the safety and the effectiveness of the deep anterior lamellar keratoplasty performed with Intralase® femtosecond laser (femtoDALK).
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.
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.
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.
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