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Callou TP, Garcia R, Mukai A, Giacomin NT, de Souza RG, Bechara SJ. Advances in femtosecond laser technology. Clin Ophthalmol 2016; 10:697-703. [PMID: 27143847 PMCID: PMC4844446 DOI: 10.2147/opth.s99741] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Femtosecond laser technology has become widely adopted by ophthalmic surgeons. The purpose of this study is to discuss applications and advantages of femtosecond lasers over traditional manual techniques, and related unique complications in cataract surgery and corneal refractive surgical procedures, including: LASIK flap creation, intracorneal ring segment implantation, presbyopic treatments, keratoplasty, astigmatic keratotomy, and intrastromal lenticule procedures.
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Affiliation(s)
| | - Renato Garcia
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana Mukai
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Samir J Bechara
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
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Zhang C, Bald M, Tang M, Li Y, Huang D. Interface quality of different corneal lamellar-cut depths for femtosecond laser-assisted lamellar anterior keratoplasty. J Cataract Refract Surg 2015; 41:827-35. [PMID: 25747165 DOI: 10.1016/j.jcrs.2014.08.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/31/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the interface quality of different corneal lamellar-cut depths with the femtosecond laser and determine a feasible range of depth for femtosecond laser-assisted lamellar anterior keratoplasty. SETTING Casey Eye Institute, Portland, Oregon, USA. DESIGN Experimental study. METHODS Full lamellar cuts were made on 20 deepithelialized human cadaver corneas using the femtosecond laser. The cut depth was 17% to 21% (100 μm), 31%, 35%, 38% to 40%, and 45% to 48% of the central stromal thickness. Scanning electron microscopy images of the cap and bed surfaces were subjectively graded for ridge and roughness using a scale of 1 to 5 (1 = best). The graft-host match was evaluated by photography and optical coherence tomography in a simulated procedure. RESULTS The ridge score was correlated with the cut depth (P = .0078, R = 0.58) and better correlated with the percentage cut depth (P = .00024, R = 0.73). The shallowest cuts had the fewest ridges (score 1.25). The 31% cut depth produced significantly fewer ridges (score 2.15) than deeper cuts. The roughness score ranged from 2.19 to 3.08 for various depths. A simulated procedure using a 100 μm host cut and a 177 μm (31%) graft had a smooth interface and flush anterior junction using an inverted side-cut design. CONCLUSIONS The femtosecond laser produced more ridges in deeper lamellar cuts. A depth setting of 31% stromal thickness might produce adequate surface quality for femtosecond laser-assisted lamellar anterior keratoplasty. The inverted side-cut design produced good edge apposition even when the graft was thicker than the host lamellar-cut depth. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- Chenxing Zhang
- From the Center for Ophthalmic Optics & Lasers (Zhang, Bald, Tang, Li, Huang), Casey Eye Institute and Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA; the Southwest Eye Hospital (Zhang), Third Military Medical University, Chongqing, China
| | - Matthew Bald
- From the Center for Ophthalmic Optics & Lasers (Zhang, Bald, Tang, Li, Huang), Casey Eye Institute and Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA; the Southwest Eye Hospital (Zhang), Third Military Medical University, Chongqing, China
| | - Maolong Tang
- From the Center for Ophthalmic Optics & Lasers (Zhang, Bald, Tang, Li, Huang), Casey Eye Institute and Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA; the Southwest Eye Hospital (Zhang), Third Military Medical University, Chongqing, China
| | - Yan Li
- From the Center for Ophthalmic Optics & Lasers (Zhang, Bald, Tang, Li, Huang), Casey Eye Institute and Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA; the Southwest Eye Hospital (Zhang), Third Military Medical University, Chongqing, China
| | - David Huang
- From the Center for Ophthalmic Optics & Lasers (Zhang, Bald, Tang, Li, Huang), Casey Eye Institute and Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA; the Southwest Eye Hospital (Zhang), Third Military Medical University, Chongqing, China.
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Iovieno A, Chowdhury V, Stevens JD, Maurino V. Moorfields technique of donor cornea mounting for femtosecond-assisted keratoplasty: use of viscoelastic in the artificial anterior chamber. Ophthalmic Surg Lasers Imaging Retina 2012; 43:348-50. [PMID: 22788587 DOI: 10.3928/15428877-20120618-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 03/22/2012] [Indexed: 11/20/2022]
Abstract
Appropriate mounting and cutting of the donor sclero-corneal cap is often cumbersome during femtosecond laser-assisted keratoplasty. The authors describe a technique for donor cornea femtosecond laser cutting using ophthalmic viscoelastic devices. The donor sclero-corneal cap is mounted on the artificial anterior chamber using a dispersive ophthalmic viscoelastic device instead of saline solution. The chances of artificial anterior chamber pressure loss, inadequate applanation, and fluid leaks are consistently reduced with the use of dispersive ophthalmic viscoelastic devices. The speed of donor femtosecond laser cutting is increased. The viscosity and elasticity of dispersive ophthalmic viscoelastic devices greatly assist the procedure with regard to ease of applanation, corneal endothelium protection, and decreased distortion of the applanated cornea.
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Affiliation(s)
- Alfonso Iovieno
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom.
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