Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results
To compare the clinical outcomes in femtosecond laser–assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting. Single-center, comparative, retrospective interventional case ser...
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| Veröffentlicht in: | American journal of ophthalmology 2020-12, Vol.220, p.191-202 |
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| creator | Gadhvi, Kunal A. Romano, Vito Fernández-Vega Cueto, Luis Aiello, Francesco Day, Alexander C. Gore, Daniel M. Allan, Bruce D. |
| description | To compare the clinical outcomes in femtosecond laser–assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting.
Single-center, comparative, retrospective interventional case series.
Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. Setting: Moorfields Eye Hospital, London. Observations: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MainOutcomeMeasures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40.
We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825).
Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting. |
| doi_str_mv | 10.1016/j.ajo.2020.07.023 |
| format | Article |
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Single-center, comparative, retrospective interventional case series.
Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. Setting: Moorfields Eye Hospital, London. Observations: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MainOutcomeMeasures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40.
We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825).
Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/j.ajo.2020.07.023</identifier><identifier>PMID: 32707206</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Archives & records ; Audits ; Cornea ; Cornea - pathology ; Cornea - surgery ; Corneal Topography - methods ; Dissection ; Endothelium ; Eye surgery ; Female ; Follow-Up Studies ; Humans ; Keratoconus - diagnosis ; Keratoconus - surgery ; Keratoplasty, Penetrating - methods ; Laser Therapy - methods ; Lasers ; Male ; Retrospective Studies ; Surgeons ; Transplants & implants ; Treatment Outcome ; Visual Acuity</subject><ispartof>American journal of ophthalmology, 2020-12, Vol.220, p.191-202</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-35d130c242f49d502e5a02b946bb8ab6a9ef0b377169629b0023d49e4be0171c3</citedby><cites>FETCH-LOGICAL-c381t-35d130c242f49d502e5a02b946bb8ab6a9ef0b377169629b0023d49e4be0171c3</cites><orcidid>0000-0002-5148-7643</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002939420303809$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32707206$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gadhvi, Kunal A.</creatorcontrib><creatorcontrib>Romano, Vito</creatorcontrib><creatorcontrib>Fernández-Vega Cueto, Luis</creatorcontrib><creatorcontrib>Aiello, Francesco</creatorcontrib><creatorcontrib>Day, Alexander C.</creatorcontrib><creatorcontrib>Gore, Daniel M.</creatorcontrib><creatorcontrib>Allan, Bruce D.</creatorcontrib><title>Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results</title><title>American journal of ophthalmology</title><addtitle>Am J Ophthalmol</addtitle><description>To compare the clinical outcomes in femtosecond laser–assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting.
Single-center, comparative, retrospective interventional case series.
Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. Setting: Moorfields Eye Hospital, London. Observations: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MainOutcomeMeasures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40.
We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825).
Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.</description><subject>Adult</subject><subject>Archives & records</subject><subject>Audits</subject><subject>Cornea</subject><subject>Cornea - pathology</subject><subject>Cornea - surgery</subject><subject>Corneal Topography - methods</subject><subject>Dissection</subject><subject>Endothelium</subject><subject>Eye surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Keratoconus - diagnosis</subject><subject>Keratoconus - surgery</subject><subject>Keratoplasty, Penetrating - methods</subject><subject>Laser Therapy - methods</subject><subject>Lasers</subject><subject>Male</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Visual Acuity</subject><issn>0002-9394</issn><issn>1879-1891</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxi0EotvCA3BBkbhwSfC_tWM4rUoLiEVICM6W40wqR0m8eByk3ngH3pAnwattOXDgNJrxbz59no-QZ4w2jDL1amzcGBtOOW2obigXD8iGtdrUrDXsIdlQSnlthJFn5BxxLK3SUj8mZ4JrqjlVG3JzDXOOCD4ufbV3COn3z187xIAZ-uotwKHaLRlSiKk8zzBNLlUfIbkcD5PDfFsN8X5QNFZ8XX1apxxqXNMNxKX6Alh6fEIeDW5CeHpXL8i366uvl-_r_ed3Hy53-9qLluVabHsmqOeSD9L0W8ph6yjvjFRd17pOOQMD7YTWTBnFTVc-KHppQHZAmWZeXJCXJ91Dit9XwGzngP5oe4G4oi3KmhstpSroi3_QMa5pKe4KpbhkrRCsUOxE-RQREwz2kMLs0q1l1B5TsKMtKdhjCpZqWwyVned3yms3Q_934_7sBXhzAqCc4keAZNEHWDz0IYHPto_hP_J_ABW3mGA</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Gadhvi, Kunal A.</creator><creator>Romano, Vito</creator><creator>Fernández-Vega Cueto, Luis</creator><creator>Aiello, Francesco</creator><creator>Day, Alexander C.</creator><creator>Gore, Daniel M.</creator><creator>Allan, Bruce D.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5148-7643</orcidid></search><sort><creationdate>202012</creationdate><title>Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results</title><author>Gadhvi, Kunal A. ; Romano, Vito ; Fernández-Vega Cueto, Luis ; Aiello, Francesco ; Day, Alexander C. ; Gore, Daniel M. ; Allan, Bruce D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-35d130c242f49d502e5a02b946bb8ab6a9ef0b377169629b0023d49e4be0171c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Archives & records</topic><topic>Audits</topic><topic>Cornea</topic><topic>Cornea - pathology</topic><topic>Cornea - surgery</topic><topic>Corneal Topography - methods</topic><topic>Dissection</topic><topic>Endothelium</topic><topic>Eye surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Keratoconus - diagnosis</topic><topic>Keratoconus - surgery</topic><topic>Keratoplasty, Penetrating - methods</topic><topic>Laser Therapy - methods</topic><topic>Lasers</topic><topic>Male</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Visual Acuity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gadhvi, Kunal A.</creatorcontrib><creatorcontrib>Romano, Vito</creatorcontrib><creatorcontrib>Fernández-Vega Cueto, Luis</creatorcontrib><creatorcontrib>Aiello, Francesco</creatorcontrib><creatorcontrib>Day, Alexander C.</creatorcontrib><creatorcontrib>Gore, Daniel M.</creatorcontrib><creatorcontrib>Allan, Bruce D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gadhvi, Kunal A.</au><au>Romano, Vito</au><au>Fernández-Vega Cueto, Luis</au><au>Aiello, Francesco</au><au>Day, Alexander C.</au><au>Gore, Daniel M.</au><au>Allan, Bruce D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2020-12</date><risdate>2020</risdate><volume>220</volume><spage>191</spage><epage>202</epage><pages>191-202</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><abstract>To compare the clinical outcomes in femtosecond laser–assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting.
Single-center, comparative, retrospective interventional case series.
Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. Setting: Moorfields Eye Hospital, London. Observations: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MainOutcomeMeasures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40.
We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825).
Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32707206</pmid><doi>10.1016/j.ajo.2020.07.023</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-5148-7643</orcidid></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Archives & records Audits Cornea Cornea - pathology Cornea - surgery Corneal Topography - methods Dissection Endothelium Eye surgery Female Follow-Up Studies Humans Keratoconus - diagnosis Keratoconus - surgery Keratoplasty, Penetrating - methods Laser Therapy - methods Lasers Male Retrospective Studies Surgeons Transplants & implants Treatment Outcome Visual Acuity |
| title | Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results |
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