Abstract
Objective
To assess the use of a new polygonal trephination pattern for deep anterior lamellar
keratoplasty (DALK) assisted by femtosecond laser.
Design
Prospective, nonrandomized clinical study.
Methods
Twenty-four eyes underwent decagonal DALK. All except 1 had advanced keratoconus.
A laser was used to create decagonal cuts on both donor and recipient corneas. All
patients were assessed for uncorrected visual acuity, best spectacle-corrected visual
acuity (BCVA), and keratometry by Pentacam pre- and postoperatively.
Results
All eyes were treated successfully without intraoperative complications. All patients
were followed for 18 months. Mean ± SD of postoperative BCVA was 0.26 ± 0.16 (logarithm
of minimal angle of resolution), and there was a significant improvement in BCVA after
6 months. At 18 months, mean ± SD postoperative average K was 44.48 ± 0.87 D, which was significantly lower than preoperative average K (58.42 ± 12.1). Postoperative astigmatism at 18 months (mean ± SD: 1.82 ± 0.67) was
significantly lower than that at 6 months (mean ± SD: 3.27 ± 0.81) (p = 0.001).
Conclusions
Use of the decagonal trephination profile was effective to perform DALK. This study
showed promising visual and refractive results. Longer follow-up, larger pool of patients,
and comparative studies are necessary to determine advantages and optimal surgical
settings of this technique.
Résumé
Objectif
Évaluer le recours à un nouveau profil de trépanation polygonal pour la kératoplastie
lamellaire antérieure profonde (KLAP) assistée par laser femtoseconde.
Nature
Étude clinique prospective non randomisée.
Méthodes
24 yeux ont subi une KLAP à découpe décagonale. Tous sauf un avaient un kératocône
avancé. Un laser Femtec (Technolas, PerfectVision, Heidelberg, Allemagne) a été utilisé
pour réaliser des découpes décagonales sur les cornées des donneurs et des receveurs.
Pour tous les patients, on a évalué l’acuité visuelle non corrigée et la meilleure
acuité visuelle corrigée (MAVC) et on a relevé les valeurs kératométriques à l’aide
d’un topographe Pentacam (OCULUS Optikgeräte GmbH, Wetzlar, Allemagne), avant et après
l’intervention.
Résultats
Tous les yeux ont été traités avec succès sans complications intraopératoires. Tous
les patients ont été suivis pendant 18 mois. La moyenne ± l’écart-type (ET) de la
MAVC postopératoire était de 0,26 ± 0,16 (logarithme de l’angle minimal de résolution) et il y avait une nette amélioration
de la MAVC après 6 mois. À 18 mois, le K moyen postopératoire était de 44,48 ± 0,87 D, soit une valeur très inférieure au K moyen préopératoire (58,42 ± 12,1). L’astigmatisme postopératoire à 18 mois (ET moyen± : 1,82 ± 0,67) était beaucoup plus faible qu’à 6 mois (ET moyen± : 3,27 ± 0,81). P = 0,001.
Conclusions
Le recours au profil de trépanation polygonal a été efficace pour la réalisation de
la KLAP. Cette étude a montré des résultats visuels et réfractifs prometteurs. Un
suivi plus long, un bassin de patients plus vaste et des études comparatives sont
nécessaires pour déterminer les avantages et les paramètres chirurgicaux optimaux
de cette technique.
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Article info
Publication history
Accepted:
December 7,
2015
Received in revised form:
December 5,
2015
Received:
May 17,
2015
Identification
Copyright
© 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
