ESCRS - PP08.05 - Clinical And Surgical Indicators Of Long-Term Positive Outcome After Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty

Clinical And Surgical Indicators Of Long-Term Positive Outcome After Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty

Published 2024 - 42nd Congress of the ESCRS

Reference: PP08.05 | Type: Free paper | DOI: 10.82333/j0dc-cr68

Authors: Francesco Pozzo Giuffrida* 1 , Mike Zein 1 , Sonia Yoo 1 , Florence Cabot 1

1Ophthalmology,Bascom Palmer Eye Institute,Miami,United States

Purpose

To study the preoperative parameters that can predict long-term clinical and visual outcomes after Femtosecond-laser Assisted Lamellar Keratoplasty (FALK).

Setting

This study was conducted at the Department of Ophthalmology, Bascom Palmer Eye Institute in Miami, FL.

Methods

This retrospective study includes data from 32 eyes who underwent FALK between November 2003 and October 2020. All the patients were subject to a complete ophthalmological evaluation at baseline and at least a yearly follow-up visit with best-corrected visual acuity (BCVA) measurements, slit lamp biomicroscopy and anterior segment OCT. The type and rate of complications and recurrences were documented. The depth of the recipient corneal lesion and the thickness of the lenticule donor graft was used as baseline predictor variables for the maximal and final VA. Pearson’s X2 test, Wilcoxon signed-rank test and univariate linear regression analysis were performed. A p-value <0.05 was considered statistically significant.

Results

Eyes that underwent FALK due to corneal scarring secondary to infectious keratitis (preop BCVA 0.67±0.43 LogMAR) or corneal trauma (preop BCVA 0.87±0.50 LogMAR) significantly increased their BCVA after surgery (max BCVA 0.32 ± 0.36 LogMAR, p=0.005 and 0.34±0.29 LogMAR, p=0.046 respectively). A significant positive association emerged between the preop flap thickness and the time required to achieve the maximal visual acuity (OR=0.883, 95%CI 0.280-1.387; p=0.006); a thicker graft required longer to achieve the maximal visual acuity. Granular dystrophy was associated with an increased risk of recurrence (recurrence in 4 out of 5 eyes, 80%; p=0.002) and a worst visual outcome (preop BCVA 0.44±0.14 LogMAR to max BCVA 0.31±0.23 LogMAR; p=0.138).

Conclusions

FALK allows for a favorable long-term visual acuity outcome in eyes with injuries showing a low tendency to recur (i.e. infectious keratitis and corneal scars). Conversely, in eyes with Granular Dystrophy, there is a significant tendency for recurrence and a poor long-term visual outcome. Additionally, a thinner flap is correlated with a faster achievement of maximal visual acuity.