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Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls.

El-Husseiny M, Seitz B, Langenbucher A, Akhmedova E, Szentmary N, Hager T, Tsintarakis T, Janunts E - J Ophthalmol (2015)

Bottom Line: Results.In particular, in group III, severe vis a tergo occurred in 8 eyes.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany.

ABSTRACT
Purpose. To assess the intraoperative results comparing two non-mechanical laser assisted penetrating keratoplasty approaches in keratoconus and Fuchs dystrophy. Patients and Methods. 68 patients (age 18 to 87 years) with keratoconus or Fuchs dystrophy were randomly distributed to 4 groups. 35 eyes with keratoconus and 33 eyes with Fuchs dystrophy were treated with either excimer laser ([Exc] groups I and II) or femtosecond laser-assisted ([FLAK] groups III and IV) penetrating keratoplasty. Main intraoperative outcome measures included intraoperative decentration, need for additional interrupted sutures, alignment of orientation markers, and intraocular positive pressure (vis a tergo). Results. Intraoperative recipient decentration occurred in 4 eyes of groups III/IV but in none of groups I/II. Additional interrupted sutures were not necessary in groups I/II but in 5 eyes of groups III/IV. Orientation markers were all aligned in groups I/II but were partly misaligned in 8 eyes of groups III/IV. Intraocular positive pressure grade was recognized in 12 eyes of groups I/II and in 19 eyes of groups III/IV. In particular, in group III, severe vis a tergo occurred in 8 eyes. Conclusions. Intraoperative decentration, misalignment of the donor in the recipient bed, and need for additional interrupted sutures as well as high percentage of severe intraocular positive pressure were predominantly present in the femtosecond laser in keratoconus eyes.

No MeSH data available.


Related in: MedlinePlus

Corneal button sutured with double-running cross-stitch suture six weeks after excimer laser keratoplasty and 8 cardinal sutures for temporary fixation have been removed at the end of surgery.
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fig4: Corneal button sutured with double-running cross-stitch suture six weeks after excimer laser keratoplasty and 8 cardinal sutures for temporary fixation have been removed at the end of surgery.

Mentions: In all patients, a peripheral iridotomy was performed at the 12-o'clock position [16]. After temporary fixation of the donor button in the recipient bed with 8 interrupted sutures, a permanent wound closure was achieved by a 16-bite double-running diagonal cross-stitch suture (10–0 nylon) according to Hoffmann [17] (Figure 4). We attempted to suture as deep as 90% of the total corneal thickness. The eight cardinal sutures were placed at the site of orientation teeth with the excimer laser and at the site of the alignment incisions with the femtosecond laser as well as possible (Figure 5). In cases of wound gaping or graft override, additional interrupted sutures were used to ensure proper donor-host alignment at the end of surgery.


Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls.

El-Husseiny M, Seitz B, Langenbucher A, Akhmedova E, Szentmary N, Hager T, Tsintarakis T, Janunts E - J Ophthalmol (2015)

Corneal button sutured with double-running cross-stitch suture six weeks after excimer laser keratoplasty and 8 cardinal sutures for temporary fixation have been removed at the end of surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4592921&req=5

fig4: Corneal button sutured with double-running cross-stitch suture six weeks after excimer laser keratoplasty and 8 cardinal sutures for temporary fixation have been removed at the end of surgery.
Mentions: In all patients, a peripheral iridotomy was performed at the 12-o'clock position [16]. After temporary fixation of the donor button in the recipient bed with 8 interrupted sutures, a permanent wound closure was achieved by a 16-bite double-running diagonal cross-stitch suture (10–0 nylon) according to Hoffmann [17] (Figure 4). We attempted to suture as deep as 90% of the total corneal thickness. The eight cardinal sutures were placed at the site of orientation teeth with the excimer laser and at the site of the alignment incisions with the femtosecond laser as well as possible (Figure 5). In cases of wound gaping or graft override, additional interrupted sutures were used to ensure proper donor-host alignment at the end of surgery.

Bottom Line: Results.In particular, in group III, severe vis a tergo occurred in 8 eyes.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany.

ABSTRACT
Purpose. To assess the intraoperative results comparing two non-mechanical laser assisted penetrating keratoplasty approaches in keratoconus and Fuchs dystrophy. Patients and Methods. 68 patients (age 18 to 87 years) with keratoconus or Fuchs dystrophy were randomly distributed to 4 groups. 35 eyes with keratoconus and 33 eyes with Fuchs dystrophy were treated with either excimer laser ([Exc] groups I and II) or femtosecond laser-assisted ([FLAK] groups III and IV) penetrating keratoplasty. Main intraoperative outcome measures included intraoperative decentration, need for additional interrupted sutures, alignment of orientation markers, and intraocular positive pressure (vis a tergo). Results. Intraoperative recipient decentration occurred in 4 eyes of groups III/IV but in none of groups I/II. Additional interrupted sutures were not necessary in groups I/II but in 5 eyes of groups III/IV. Orientation markers were all aligned in groups I/II but were partly misaligned in 8 eyes of groups III/IV. Intraocular positive pressure grade was recognized in 12 eyes of groups I/II and in 19 eyes of groups III/IV. In particular, in group III, severe vis a tergo occurred in 8 eyes. Conclusions. Intraoperative decentration, misalignment of the donor in the recipient bed, and need for additional interrupted sutures as well as high percentage of severe intraocular positive pressure were predominantly present in the femtosecond laser in keratoconus eyes.

No MeSH data available.


Related in: MedlinePlus