FEMTOSECOND LASER-ASSISTED KERATOPLASTY: WOUND INTEGRITY IN EYE BANK EYES

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FEMTOSECOND LASER-ASSISTED KERATOPLASTY WOUND
INTEGRITY IN EYE BANK EYES

• João Baptista Malta, MD, H. Kaz Soong, MD, Roni
  Shtein, MD, Michael Banitt, MHA, MD, David C.
  Musch, PhD, MPH, Alan Sugar, MD, and Shahzad I.
  Mian, MD

DEPARTMENT OF OPHTHALMOLOGY AND VISUAL SCIENCES
W.K. KELLOGG EYE CENTER UNIVERSITY OF MICHICAN
Financial interest disclosure None for all
authors
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PURPOSE

• To optimize the surgical technique for performing
  Femtosecond Laser-Assisted Keratoplasty (FLAK) to
  cut both recipient and donor corneal buttons
  using the IntraLase FS
• To test the stability and integrity of the
  incisions closed with different methods

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METHODS

• FLAK performed in 6 human globes and 6
  corneoscleral buttons for each of the following
  trephination patterns
• Top hat
• Mushroom
• Tongue-groove
• Vertical
• Manual trephination as control

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Cross-sectional schematic diagram of laser cuts
and measurements in mushroom pattern
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METHODS

• Incision closure with
• 8 sutures
• 8 sutures with fibrin adhesive
• 16 sutures
• Wound integrity measured with intraocular
  pressure required to produce graft-host wound
  leakage (IOPL) and dehiscence

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RESULTS

• Mushroom and top hat FLAK had significantly
  higher IOPL than vertical or manual trephination
  (plt0.001) for wounds closed with 16 sutures.
• There was no difference in IOPL between top hat,
  mushroom, and tongue-groove FLAK in wounds closed
  with 8 sutures with fibrin adhesive (pgt0.75).

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Mean intraocular pressure leakage (IOPL) (mm Hg)
of keratoplasty procedure comparing suture
technique
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Mean intraocular pressure leakage (IOPL) (mm Hg)
of suture technique comparing keratoplasty
procedure
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CONCLUSION

• These preliminary studies show that FLAK produces
  precise trephination cuts of superior wound
  strength and stability to that of manual
  trephination.
• Adjuvant fibrin glue may further improve wound
  integrity.

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REFERENCES

• Steinert RF, Ignacio TS, Sarayba MA. "Top
  hat"-shaped penetrating keratoplasty using the
  femtosecond laser. Am J Ophthalmol
  2007143689-91.
• Bahar I, Kaiserman I, Slomovic A, McAllum P,
  Rootman D. Fibrin glue for opposing wound edges
  in "Top Hat" penetrating keratoplasty a
  laboratory study. Cornea 2007261235-8.
• Ignacio TS, Nguyen TB, Chuck RS, Kurtz RM,
  Sarayba MA. Top hat wound configuration for
  penetrating keratoplasty using the femtosecond
  laser a laboratory model. Cornea 200625336-40.