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Femtosecond laser-assisted decagonal deep anterior lamellar keratoplasty

      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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