Elsevier

Ophthalmology

Volume 116, Issue 9, September 2009, Pages 1638-1643
Ophthalmology

Original article
Comparison of Penetrating Keratoplasty Performed with a Femtosecond Laser Zig-Zag Incision versus Conventional Blade Trephination

https://doi.org/10.1016/j.ophtha.2009.05.003Get rights and content

Purpose

To evaluate visual outcomes and astigmatism in patients who underwent penetrating keratoplasty (PK) with 2 different incision techniques.

Design

Retrospective comparison of a consecutive surgical series.

Participants

Fifty-seven consecutive patients who underwent PK at the University of California, Irvine, academic referral practice.

Methods

A comparison of 49 eyes of 43 patients that underwent femtosecond laser zig-zag incision pattern PK versus 17 eyes of 14 patients that underwent conventional Barron suction trephination PK performed contemporaneously. All PKs were closed with an identical, 24-bite running nylon suture technique.

Main Outcome Measures

Topographically determined astigmatism, best spectacle-corrected visual acuity (BSCVA), and recovery of full visual potential.

Results

The postoperative follow-up ranged from 1 to 12 months. There was a significant difference in average astigmatism between the groups at postoperative month 1 (P = 0.013) and 3 (P = 0.018). By month 3, the average astigmatism was 3 diopters (D) in the zig-zag group and 4.46 D in the conventional group. Of the patients with normal macular and optic nerve function (nZZ = 32; ncon = 14), a significant difference in BSCVA was seen at month 1 (P = 0.0003) and month 3 (P = 0.006) with 81% of the zig-zag group versus 45% of the conventional group achieving BSCVA of ≥20/40 by month 3 (P = 0.03).

Conclusions

The femtosecond laser generated zig-zag–shaped incision results in a more rapid recovery of BSCVA and induces less astigmatism compared with conventional blade trephination PK.

Financial Disclosure(s)

Proprietary commercial disclosure may be found after the references.

Section snippets

Methods

Results are reported for consecutive cases of PK performed using the IntraLase femtosecond laser (Abbott Medical Optics, Santa Ana, CA) to make zig-zag pattern donor and host corneal incisions and compared with contemporaneous consecutive cases of conventional PK performed with conventional suction blade trephination, with the limitation that all cases were closed with a single, 24-bite running 10-0 nylon suture technique in both groups. The surgeries were all performed at the University of

Results

Table 1 summarizes the demographic and diagnosis information for the zig-zag group and the conventional group. A 24-bite, 10-0 nylon, running suture technique was used for all cases. Length of follow-up was 12 months for 18 eyes (nZZ = 13; ncon = 5), 9 months for 9 eyes (nZZ = 5; ncon = 4), 6 months for 14 eyes (nZZ = 9; ncon = 5), 3 months for 13 eyes (nZZ = 10; ncon = 3), and 1 month for 12 eyes (nZZ = 12; ncon = 0). The 2 groups were similar in age (rangeZZ, 19–98 years; rangeconv, 40–76

Discussion

In this retrospective case series, the femtosecond-generated zig-zag incision PK demonstrated faster recovery of BSCVA and less induced astigmatism than conventional blade trephination PK. Although our contemporaneous comparison group was small and not randomized, the level and speed of recovery of BSCVA that we saw in the zig-zag group exceed most previously reported visual acuity results with conventional PK. In this series, >75% of eyes with normal macular potential achieved ≥20/40 driving

References (14)

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Manuscript no. 2008-1129.

Abbott Medical Optics provided supplies and equipment in support of the procedures.

Financial Disclosure(s): The authors have made the following disclosures: Roger F. Steinert - Consultant - Abbott Medical Optics (no financial interest in the femtosecond laser or the techniques in this investigation)

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