Femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty

Clara C. Chan, Rusty J. Ritenour, Nikhil L. Kumar, Wiwan Sansanayudh, David S. Rootman

    Research output: Contribution to journalReview article

    36 Citations (Scopus)

    Abstract

    Purpose: To review patient outcomes after femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty. Methods: Seven eyes of seven patients with a mean age of 30 years underwent femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty from April 2008 to September 2008. Patients had keratoconus, corneal ectasia or scarring. Set for 100 μm of residual cornea, the femtosecond laser was used to create a mushroom-shaped recipient bed and donor button (having a larger anterior than posterior diameter). The posterior central lamella was manually dissected using Melles technique. Results: Mean follow up was 4 months (range, 3-6.5 months). Preoperative mean best-corrected visual acuity was 20/95 (range, 20/40-20/400). Intraoperative complications included two cases (28.6%) of small Descemet membrane perforation. Postoperatively, there was one case of stromal rejection that resolved with topical steroids and two cases of steroid-related intraocular pressure rise that were treated with a prostaglandin analog. At 3 months, mean best-corrected visual acuity was 20/40 (range, 20/25-20/60), mean spherical equivalent refraction was -3.21 D (range, -6.75 D to plano), mean cylindrical refractive error was 3.57 D (range, 1.5-7 D), and mean keratometric cylinder measured 5.56 D (range, 3.79-7.00 D). Selective suture removal occurred in six patients (86%) at a mean of 3.8 months (range, 2-6 months) postoperatively. Conclusions: This preliminary series demonstrates that the use of the femtosecond laser to perform corneal cuts in a mushroom configuration for deep anterior lamellar keratoplasty is feasible. The mechanical stability and wound healing advantages for stepped corneal wounds should be considered in lamellar surgery.

    Original languageEnglish
    Pages (from-to)290-295
    Number of pages6
    JournalCornea
    Volume29
    Issue number3
    DOIs
    Publication statusPublished - Mar 2010

    Keywords

    • DALK
    • Deep anterior lamellar keratoplasty
    • Femtosecond laser
    • Keratoconus
    • Mushroom keratoplasty

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    Chan, C. C., Ritenour, R. J., Kumar, N. L., Sansanayudh, W., & Rootman, D. S. (2010). Femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty. Cornea, 29(3), 290-295. https://doi.org/10.1097/ICO.0b013e3181b77873