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Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results

Gadhvi, KA; Romano, V; Fernández-Vega Cueto, L; Aiello, F; Day, AC; Gore, DM; Allan, BD; (2020) Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results. American Journal of Ophthalmology , 220 pp. 191-202. 10.1016/j.ajo.2020.07.023. Green open access

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Abstract

PURPOSE: To compare the clinical outcomes in femtosecond laser–assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting. DESIGN: Single-center, comparative, retrospective interventional case series. METHODS: Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. Setting: Moorfields Eye Hospital, London. Observations: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. Main Outcome Measures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40. RESULTS: We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825). CONCLUSION: Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.

Type: Article
Title: Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ajo.2020.07.023
Publisher version: https://doi.org/10.1016/j.ajo.2020.07.023
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10157050
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