Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK)

Boris E. Malyugin, Alexandra Belodedova, Olga Antonova, Aslan Gelyastanov, Raimo Tuuminen, Eliya Levinger, Asaf Achiron, Boris Knyazer

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet’s membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography. Materials and methods: A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group). Results: In the full FS-DALK group, the BB’s formation was significantly higher (64.3% vs. 36.4%, p = 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min, p = 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%, p = 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%, p < 0.001 for both comparisons). Conclusions: Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time. [InlineMediaObject not available: see fulltext.].

Original languageEnglish
Pages (from-to)185-191
Number of pages7
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume261
Issue number1
DOIs
StatePublished - 1 Jan 2023
Externally publishedYes

Keywords

  • Big bubble
  • Corneal endothelium
  • Deep anterior lamellar keratoplasty
  • Femtosecond laser
  • Keratoconus

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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