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Femtosecond laser-assisted half-top-hat keratoplasty

Poster Details

First Author: A.Cano SPAIN

Co Author(s):    A. Villarrubia   M. Cantais   I. Porcuna        

Abstract Details



Purpose:

Shaped keratoplasties, such as the top-hat, zigzag, and mushroom keratoplasties, have been reported to have advantages over traditional penetrating keratoplasty (PK). The manual versions of these techniques are technically difficult because of hand dissection in both, the donor and recipient. Use of a femtosecond laser (FSL) allows for more consistent results, but this device is not available in the majority of surgical rooms. We want to show in this paper our surgical technique which has already been described by Matthew J. Thompson as a modification to the manual half-top-hat technique described by Kaiserman et al. With this technique, FSL is only needed to create the shape in the donor cornea allowing for a shaped PK without the use of any additional equipment in the surgical room

Setting:

Instituto de Oftalmología La Arruzafa de Córdoba (Spain)

Methods:

We have operated with this technique two men (32 and 22 years old), both with irregular post-injury corneal leucoma. The donor was previously prepared in our surgical room for refractive surgery with all the usual asepsis care. We used the FS-200 FSL (Alcon, California), in a half-top-hat configuration with the parameters described by Thompson. The patient’s cornea was trephine with a 7.5-mm manual trephine and the graft was implanted using 10-0 nylon sutures, passing each suture through the edge of the inner portion of the graft and then full thickness through the recipient as described by Thompson

Results:

We have operated with this technique two men (32 and 22 years old), both with irregular post-injury corneal leucoma. The donor was previously prepared in our surgical room for refractive surgery with all the usual asepsis care. We used the FS-200 FSL (Alcon, California), in a half-top-hat configuration with the parameters described by Thompson. The patient’s cornea was trephine with a 7.5-mm manual trephine and the graft was implanted using 10-0 nylon sutures, passing each suture through the edge of the inner portion of the graft and then full thickness through the recipient as described by Thompson

Conclusions:

A combining approach for shaped keratoplasty, like top-hat, using the FSL in the donor cornea and a manual trephine in the recipient (FSL–assisted half-top-hat keratoplasty) allows some of the advantages of shaped keratoplasty, such as improved wound strength, while eliminating the drawbacks of a fully manual or fully FSL shaped keratoplasties (access to lasers, recipient beds with cloudy corneas that do not allow the use of the FSL to perform the keratotomy). The technique has not learning curve and does not require any additional steps beyond those of traditional PK. Making the donor trephination in an eye bank with a FSL could be an important step to eliminate the problems for a widespread use of shaped PK

Financial Disclosure:

NONE

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