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Bibak-Bejandi Z, Mohammadi SF, Davoudi M, Bahmanpour A, Asadi-Amoli F. A New Technique for Harvesting Limbal Stem Cell Tissue for Transplantation Using an Automated Microkeratome and a Novel Globe-Fixation System. Cornea 2024:00003226-990000000-00567. [PMID: 38780455 DOI: 10.1097/ico.0000000000003572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To introduce an unprecedented technique, instrumentation, and setup for the superficial limbus harvest from the human cadaver donor whole globe. METHODS We studied several superficial limbus harvest alternatives, developed a preferred approach with our available instruments, and optimized it on a handful of (seropositive) cadaver donors of whole globes. RESULTS/TECHNIQUE The globe was pressurized to about normal intraocular pressure by viscoelastic injection through the optic nerve stump. The globe was then mounted on a dynamic globe fixator that maintained a negative pressure in its stabilizing socket. Exertion of the negative pressure effectively elevated globe intraocular pressure (to over 40 mm Hg) and made the corneoscleral wall tight. The socket was then held tilted to the left side for about 35 to 40 degrees to put the limbal zone horizontally and mildly "chin-up." Next, the microkeratome was put on the uppermost and exposed limbus of the globe and activated, and the socket was rotated clockwise under the microkeratome head and its oscillating blade, allowing an effective 360-degree revolution of the microkeratome head around the limbal belt (for a right-handed operator and a counterclockwise cut). CONCLUSIONS We consistently succeeded in peeling intact 360-degree strips of the smooth superficial limbus by using blades with varying depths. Our method can be further equipped and optimized and be used by the eye banks and the surgeons for keratolimbal grafting as a more efficient limbal stem cell tissue harvest technique.
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Affiliation(s)
- Zahra Bibak-Bejandi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Fandana Zarbin Co, Tehran, Iran; and
| | - Seyed-Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Fandana Zarbin Co, Tehran, Iran; and
| | - Mehdi Davoudi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Bahmanpour
- Fandana Zarbin Co, Tehran, Iran; and
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Fahimeh Asadi-Amoli
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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2
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Al Busaidi T. Argon laser-assisted pterygium surgery. Oman J Ophthalmol 2023; 16:399-400. [PMID: 38059093 PMCID: PMC10697249 DOI: 10.4103/ojo.ojo_240_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 12/08/2023] Open
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3
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Liu YC, Morales-Wong F, Patil M, Han SB, Lwin NC, Teo EPW, Ang HP, Yussof NZM, Mehta JS. Femtosecond laser-assisted corneal transplantation with a low-energy, liquid-interface system. Sci Rep 2022; 12:6959. [PMID: 35484198 PMCID: PMC9050694 DOI: 10.1038/s41598-022-11461-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Femtosecond laser-assisted keratoplasty has been proposed as a treatment option for corneal transplantation. In this study, we investigated and compared the outcomes of Ziemer Z8 femtosecond laser (FSL)-assisted penetrating keratoplasty (PK) using a liquid interface versus flat interface. Thirty fresh porcine eyes underwent FSL-assisted PK with the Z8 using different levels of energies (30%, 90% or 150%) and different interfaces (liquid or flat). The real-time intraocular pressure (IOP) changes, incision geometry, corneal endothelial damage, as well as the accuracy of laser cutting and tissue reaction, were performed and compared. We found that the overall average IOP at all laser trephination stages was significantly higher with the flat interface, regardless of the energy used (68.9 ± 15.0 mmHg versus 46.1 ± 16.6 mmHg; P < 0.001). The overall mean laser-cut angle was 86.2º ± 6.5º and 88.2º ± 1.0º, for the liquid and flat platform respectively, indicating minimal deviation from the programmed angle of 90º. When high energy (150%) was used, the endothelial denuded area was significantly greater with the flat interface than with liquid interface (386.1 ± 53.6 mm2 versus 139.0 ± 10.4 mm2P = 0.02). The FSL cutting did not cause obvious tissue reaction alongside the laser cut on histological evaluation. The results indicated a liquid interface is the preferable choice in FSL-assisted corneal transplantation.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore. .,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore. .,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Ophthalmology Academic Clinical Program, Singapore, Singapore.
| | - Fernando Morales-Wong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore.,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore.,Faculty of Medicine, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo Leon, San Nicolás de los Garza, Mexico
| | - Moushmi Patil
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon-si, Republic of Korea
| | - Nyein C Lwin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Ericia Pei Wen Teo
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Heng Pei Ang
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Nur Zah M Yussof
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology Academic Clinical Program, Singapore, Singapore
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4
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Moscovici BK, Rodrigues PF, Freitas MMS, e Silva FB, Felberg S, Dantas PEC. Donor graft harvesting with air in pterygium surgery. Eur J Ophthalmol 2022; 32:3103-3109. [DOI: 10.1177/11206721221090802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Report a new technique for improvement of pterygium surgery: donor graft harvesting with air. Case reports We describe a technique that was used with 138 patients who underwent surgery that included a conjunctival autograft and fibrin glue with air injection to dissect the Tenon capsule from the conjunctiva. Results No complications occurred with this technique and all patients achieved good results. Discussion The surgical time with this new technique was similar to that reported in the literature. In addition, the graft thickness was close to that reported with femtosecond laser dissection and it was thinner than that reported with aesthetic/saline dissection (unable to determine statistical significance). Conclusions and importance With the injection of an air bubble, we could easily dissect the conjunctiva from the Tenon capsule and quickly acquire thin grafts without any additional costs or complications.
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Affiliation(s)
| | | | | | | | - Sérgio Felberg
- Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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5
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Fuest M, Mehta JS. Advances in refractive corneal lenticule extraction. Taiwan J Ophthalmol 2021; 11:113-121. [PMID: 34295616 PMCID: PMC8259523 DOI: 10.4103/tjo.tjo_12_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 01/31/2023] Open
Abstract
Refractive errors are the leading cause of reversible visual impairment worldwide. In addition to the desired spectacle independence, refractive procedures can improve quality of life, working ability, and daily working performance. Refractive corneal lenticule extraction (RCLE) is a relatively new technique, dependent only on a femtosecond laser (FS). This leads to potential benefits over laser-assisted in situ keratomileusis (LASIK) including a quicker recovery of dry eye disease, a larger functional optical zone, and no flap-related complications. SMILE, available with the VisuMax FS (Carl Zeiss Meditec AG, Jena, Germany), is the most established RCLE application, offering visual and refractive outcomes comparable to LASIK. SmartSight (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) and CLEAR (Ziemer Ophthalmic Systems AG, Port, Switzerland) are two new RCLE applications that received Conformité Européenne (CE) approval in 2020. In this article, we review refractive and visual outcomes, advantages, and disadvantages of RCLE and also report on the latest advances in RCLE systems.
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Affiliation(s)
- Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Eye-Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
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Cosmetic outcome of femtosecond laser-assisted pterygium surgery. EYE AND VISION 2021; 8:7. [PMID: 33673873 PMCID: PMC7936441 DOI: 10.1186/s40662-021-00230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
Background To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery (FLAPS) with conjunctival autograft (CAG) and its potential predictive factors. Methods This was a prospective interventional case series (NCT02866968). We included 29 patients (29 eyes) with primary pterygium who underwent FLAPS. Cosmetic outcome was graded by two graders (an ophthalmology resident and an experienced ophthalmologist) using Hirst classification system (1–4 = excellent–poor). Weighted Cohen’s kappa analysis was performed to examine the intra- and inter-rater reliability. The relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients (r). Results The preoperative severity of pterygium (Tan grading system) was mild/atrophic (7%), moderate/intermediate (62%), and severe/fleshy (31%). An ultrathin CAG (mean thickness of 74.5 ± 9.8 μm) was fashioned intraoperatively. An excellent cosmetic outcome of FLAPS (median ± IQR) was observed at 3 months (1.0 ± 1.0) and remained similar at 6 months (1.0 ± 0.0) and 12 months (1.0 ± 0.0) postoperatively. At final follow-up, 27 (93%) patients achieved good-to-excellent cosmetic outcome, with 1 (3%) patient having a poor outcome due to incomplete pterygium removal. Weighted kappa analysis of Hirst grading system showed excellent intra-rater (κ = 0.86–0.95) and inter-rater reliability (κ = 0.84–0.88). There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness (r = 0.38, P = 0.06) but not with age, gender, preoperative pterygium severity, or intraoperative CAG thickness. Conclusions FLAPS can result in an excellent cosmetic outcome, which may be attributed to the beneficial effect of an ultrathin CAG. Trial registration ClinicalTrials.gov, NCT02866968. Registered in July 2016, Supplementary Information The online version contains supplementary material available at 10.1186/s40662-021-00230-w.
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7
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Dimacali VG, Liu YC, Ong HS, Ting DSJ, Mehta JS. Femtosecond laser-assisted excision of conjunctival melanocytic lesions: Cosmetic and long-term outcomes. Clin Exp Ophthalmol 2021; 49:312-315. [PMID: 33570816 PMCID: PMC8248140 DOI: 10.1111/ceo.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/05/2022]
Affiliation(s)
| | - Yu-Chi Liu
- Department of Cornea and External Diseases, Singapore National Eye Centre, Singapore.,Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Hon Shing Ong
- Department of Cornea and External Diseases, Singapore National Eye Centre, Singapore.,Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Darren S J Ting
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jodhbir S Mehta
- Department of Cornea and External Diseases, Singapore National Eye Centre, Singapore.,Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
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8
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The effects of laser displacement on femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery. PLoS One 2021; 16:e0245223. [PMID: 33444405 PMCID: PMC7808670 DOI: 10.1371/journal.pone.0245223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS To evaluate the effects of no-suction femtosecond laser (FSL) stability on conjunctival autograft (CAG) dissection in pterygium surgery. METHODS Prospective analysis of 35 eyes from 34 subjects who underwent femtosecond laser-assisted pterygium surgery with the Ziemer Z8 laser (Ophthalmic Systems AG, Switzerland). Intraoperative absolute FSL displacements were measured and correlated with the duration and ease of CAG peel, CAG thickness, measured with intraoperative optical coherence tomography, and deviation from intended graft thickness. RESULTS The median absolute FSL displacement was 22 μm (interquartile range [IQR] 14.7 to 60.8), while median vertical FSL displacement was 14.7 μm (IQR 7.3 to 44) and median horizontal FSL displacement was 22.0 μm (IQR 14.7 to 44). 65.7% had a grade 1 peel, 11.4% had grade 2 peel, 14.3% had grade 3 peel and 8.6% had grade 4 peel. The median duration of CAG peel was 5.4 seconds (IQR 3 to 21.4). The median CAG thickness was 69 μm (IQR 60.3 to 78.5), and the median deviation from targeted graft thickness was 9 μm (IQR 1 to 16). Eyes with more difficult peels and longer duration of CAG peels had significantly greater vertical FSL displacements (p = 0.04 and 0.02 respectively), but not horizontal displacement, age, ethnicity, CAG thickness or deviation from original thickness, compared to those with better quality and shorter duration peels. 1 eye (2.9%) had an incomplete CAG peel with a buttonhole and 2 eyes had graft tears (5.7%). CONCLUSION Micro-displacements during the suction-free CAG preparation are common but they did not affect the quality of the CAG peel, duration of peel, or CAG thickness. However, vertical globe displacement during FSL-assisted CAG creation was significantly associated with a more difficult and longer CAG peel duration. This highlights the importance of the cornea traction suture fixation to ensure stability of the eye during FSL application.
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9
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Mansoor H, Liu YC, Ang M, Mehta JS. Conjunctival sparing femtosecond laser-assisted conjunctival autografts for double-headed pterygium surgery. Clin Exp Ophthalmol 2020; 48:1115-1118. [PMID: 32918377 DOI: 10.1111/ceo.13860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/28/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hassan Mansoor
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Marcus Ang
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
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10
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Ting DSJ, Liu YC, Patil M, Ji AJS, Fang XL, Tham YC, Lee YF, Htoon HM, Mehta JS. Proposal and validation of a new grading system for pterygium (SLIT2). Br J Ophthalmol 2020; 105:921-924. [PMID: 32788329 DOI: 10.1136/bjophthalmol-2020-315831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/06/2020] [Accepted: 07/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIMS To propose and validate a new pterygium grading system based on slit-lamp evaluation. METHODS This prospective cross-sectional study included 217 patients with pterygium. All patients underwent slit-lamp examination, and slit-lamp photographs were independently graded by two graders twice. A total of eight parameters were evaluated and all parameters were assigned with a score of 1-4 (normal-severe). Intra-rater and inter-rater reliability as determined by weighted Cohen's kappa analysis. RESULTS A total of 868 independent assessment, based on 217 slit-lamp images, were performed by two graders. For conjunctival assessment, the intra-rater reliability was excellent for body thickness (κ=0.81-0.89) and size at limbus (κ=0.87-0.92), substantial-to-excellent for body vascularity (κ=0.72-0.86), and moderate-to-excellent for body length (κ=0.57-0.81), whereas the inter-rater reliability was excellent for size at limbus (κ=0.86), substantial for body thickness (κ=0.72-0.73) and body vascularity (κ=0.66-0.75), and moderate for body length (κ=0.54-0.57). For corneal assessment, the intra-rater reliability was excellent for all four parameters (κ=0.84-0.90) whereas the inter-rater reliability was excellent for head length (κ=0.86-0.87), substantial-to-excellent for head vascularity (κ=0.78-0.82), substantial for Stocker's line (κ=0.79-0.80) and head thickness (κ=0.67-0.69). The grading system was named SLIT2, which included S tocker's line, S ize at limbus, L ength of head/body, I njection/vascularity of body/head, and T hickness of body/head. CONCLUSION The proposed SLIT2 grading system, consisting of eight components, may serve as a reliable tool to standardise the reporting of pterygium severity and disease recurrence for clinical and research applications.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, UK.,Singapore Eye Research Institute, Singapore, Singapore
| | - Yu-Chi Liu
- Singapore Eye Research Institute, Singapore, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore, Singapore
| | - Moushmi Patil
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Xiao Ling Fang
- Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Shanghai Eye Diseases Prevention and Treatment Center, Shanghai, China
| | | | - Yi-Fang Lee
- Ophthalmology, Singapore National Eye Centre, Singapore, Singapore
| | - Hla M Htoon
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore .,Cornea And Ext Disease, Singapore National Eye Centre, Singapore, Singapore
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Han SB, Liu YC, Mohamed-Noriega K, Mehta JS. Application of Femtosecond Laser in Anterior Segment Surgery. J Ophthalmol 2020; 2020:8263408. [PMID: 32351726 PMCID: PMC7171667 DOI: 10.1155/2020/8263408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karim Mohamed-Noriega
- Department of Ophthalmology, University Hospital, Faculty of Medicine, Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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