Femtosecond Laser–Assisted Sutureless Anterior Lamellar Keratoplasty

2. Femtosecond Laser–Assisted SuturelessAnterior Lamellar Keratoplasty Einollahi MD Shahidbehshti ophthalmic excellence www.iranophthalex.com

3. Anterior LK provides several advantages over conventional full-thickness keratoplasty • Minimizes potential intraoperative Complications • Faster visual and refractive recovery • Maintaining the recipient endothelial layer decreases the rate of graft rejection • perform multiple lamellar (anterior, stromal, posterior– endothelial) corneal transplantations from one donor’s cornea

4. Anterior lamellar keratoplasty (ALK) • Is a partial-thickness corneal transplantation used in eyes with pathology limited to the anterior layers • Superficial corneal scars after Trauma keratitis epithelial/ anterior stromal dystrophies

5. Anterior stromal dystrophies

6. The major limitations with anterior LK are the technical challenges • Difficult to performing manual dissections • The resulting stromal interface irregularities between the donor and recipient interface • stromal interface haze • Induced irregular astigmatism • Loss of (BCVA)

7. Recent procedure to minimize ALK difficulties • The improvements in automated micro keratomes and artificial anterior chambers (ALTK) • Femtosecond Laser–Assisted SuturelessAnterior Lamellar Keratoplasty

8. Suturelessfemtosecond Laser–Assisted Anterior Lamellar Keratoplasty(FALK) • Highly reproducible dimensions of the cuts at the graft– host junction • Accurate the shape and corneal dimensions of the donor and recipient • safe • Efficient

9. Sutureless FALK • The high precision and reproducibility of femtosecond • A smoother donor– host interface • Less induced Irregular astigmatism and Interface haze • Faster and better wound healing, without the need for sutures • Excimer laser in the PTK mode successfully treat superficial corneal opacities or refractory error in Bed

10. The main advantages of femtosecond laser over mechanical microkeratome are • Reduced incidence of flap complications • Greater surgeon choice of flap diameter and thickness, side cut angle, hinge position, and length • A more regular corneal surface • can create flaps as thin as 90 mm

11. FALK superior than PTK

12. Sutureless FALK Surgical Technique • Performed Anterior segment ocular coherence tomography OCT before surgery • Performed under topical anesthesia • Create the donor graft with femtosecond Laser from donor globe

13. Corneal OCT

14. Sutureless FALK Surgical Technique… • The lenticule adjusted in relation to depth of the lesions according to the anterior segment OCT findings • Depending on the donor tissue quality and edema, additional thickness was added to the donor lenticule to adjust for donor tissue swelling • A recipient corneal lenticule was created using similar femtosecond laser or 0.1 mm smaller

15. Sutureless FALK Surgical Technique • After the procedure, the patient was transferred to the surgery room, where the corneal button was removed with a blunt spatula leaving the clear stromal residual bed • The keratectomy incision was dried with methylcellulose sponges • After approximately 5 minutes (to dehydrate the cornea and improve adhesion • A bandage contact lens was fitted over the cornea

16. Post operation • Patients were then placed on a topical antibiotic and steroid for 1 week, and steroid drops were slowly tapered over several months • A bandage contact lens removed over the cornea after 2 weeks

17. Sutureless FALK Surgical Technique • Femtosecond laser energy adjustments should be considered • Patients with severe corneal scars totally obscuring visualization of anterior segment structures were excludedbecause of concern that the scars’ opacification could scatter laser energy

18. Complications • Residual corneal scarring • Residual deposits • Anisometropia • Dry eye • Graft dislocation • graft rejection • Infection • Epithelial ingrowth

19. Epithelial ingrowth

20. Suture less FALK Surgical Technique

21. Suture less FALK Surgical Technique Pre OP Post OP