Femtosecond laser-assisted large superficial anterior lamellar keratoplasty in central and paracentral corneal extreme ulcerations
First Author: J.Artaechevarria Artieda SPAIN
Co Author(s): N. Estébanez Corrales N. Alejandre Alba
To describe a novel surgical technique for central and paracentral corneal extreme ulcerations in 4 patients, which consists on a modified SALK with a large diameter (over 7mm) and partially performed by femtosecond-laser.
The tertiary referral University Hospital Fundación Jiménez Díaz, Madrid, Spain.
This is a retrospective case-series of four patients that presented with central and paracentral corneal extreme ulcerations in risk of impending perforation from October 2017 to November 2018. Diagnose included complete ophthalmological examination, anterior segment-OCT and corneal photographs. Surgical technique was video recorded. In all cases an extended blood analysis was performed in order to rule out associated systemic diseases. Intraoperative and postoperative complications were noted.
Four patients were included. Etiology of the ulcers was various: one peripheral ulcerative keratitis, two herpetic ulcer thinning and one corneal scar thinning. All ulcerations were located centrally or paracentrally inside the central 4mm of the cornea. Donor grafts were prepared with femtosecond-laser with a diameter from 7.1mm to 9mm and from 200 to 300 microns of depth. Receptor cornea was manually trephined in three cases. In one case, the receptor cornea was trephined with femtosecond-laser, covering the ulceration with a marker pen to avoid laser penetration in the thinned area. No graft rejection or failures were observed.
The femtosecond laser-assisted superficial anterior lamellar keratoplasty is a simple technique that can allow acceptable visual and biomicroscopic results in patients with central and paracentral corneal severe thinning. The large graft allows the peripheral display of the sutures, avoiding the manipulation of the visual axis and the melted areas. Due to the preservation of the endothelium, the risk of rejection in this type of keratoplasties is low.