28 February 2014 Femtosecond laser assisted design of sutureless intrastromal graft as an alternative to partial thickness keratoplasty
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Proceedings Volume 8930, Ophthalmic Technologies XXIV; 89301J (2014) https://doi.org/10.1117/12.2039386
Event: SPIE BiOS, 2014, San Francisco, California, United States
Abstract
Minimally invasive laser assisted surgery in ophthalmology is continuously developing in order to find new surgical approaches, preserve patient tissue and improve surgical results in terms of cut precision, restoration of visual acuity, and invasiveness. In order to achieve these goals, the current approach in corneal transplant is lamellar keratoplasty, where only the anterior or posterior part of the patient’s cornea is substituted depending on the lesion or pathology. In this work, we present a novel alternative approach: a case study of intrastromal sutureless transplant, where a portion of the anterior stroma of a donor cornea was inserted into the stroma of the recipient cornea, aiming to restore the correct thickness of the patient’s cornea. The patient cornea was paracentrally thin, as the result of a trophic ulcer due to ocular pemphigoid. A discoid corneal graft from the anterior stroma of a donor eye was prepared: a femtosecond laser cut with a trapezoidal profile (thickness was 300 μm, minor and major basis were 3.00 and 3.50 mm, respectively). In the recipient eye, an intrastromal cut was also performed with the femtosecond laser using a specifically designed mask; the cut position was 275 μm in depth. The graft was loaded into an injector and inserted as an intrastromal presbyopic implant. The postoperative analysis evidenced a clear and stable graft that selectively restored corneal thickness in the thinned area. Intrastromal corneal transplant surgery is a minimally invasive alternative to anterior or posterior lamellar keratoplasty in select cases. We believe that Sutureless Intrastromal Laser Keratoplasty (SILK) could open up new avenues in the field of corneal transplantation by fully utilizing the potential and precision of existing lasers.
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Francesca Rossi, Francesca Rossi, Heather Durkee, Heather Durkee, Roberto Pini, Roberto Pini, Annalisa Canovetti, Annalisa Canovetti, Alex Malandrini, Alex Malandrini, Ivo Lenzetti, Ivo Lenzetti, Pierangela Rubino, Pierangela Rubino, Rosachiara Leaci, Rosachiara Leaci, Alberto Neri, Alberto Neri, Patrizia Scaroni, Patrizia Scaroni, Luca Menabuoni, Luca Menabuoni, Claudio Macaluso, Claudio Macaluso, } "Femtosecond laser assisted design of sutureless intrastromal graft as an alternative to partial thickness keratoplasty", Proc. SPIE 8930, Ophthalmic Technologies XXIV, 89301J (28 February 2014); doi: 10.1117/12.2039386; https://doi.org/10.1117/12.2039386
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