Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK)
Purpose The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet’s membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated o...
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| Veröffentlicht in: | Graefe's archive for clinical and experimental ophthalmology 2023, Vol.261 (1), p.185-191 |
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| creator | Malyugin, Boris E. Belodedova, Alexandra Antonova, Olga Gelyastanov, Aslan Tuuminen, Raimo Levinger, Eliya Achiron, Asaf Knyazer, Boris |
| description | Purpose
The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet’s membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography.
Materials and methods
A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group).
Results
In the full FS-DALK group, the BB’s formation was significantly higher (64.3% vs. 36.4%,
p
= 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min,
p
= 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%,
p
= 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%,
p
|
| doi_str_mv | 10.1007/s00417-022-05765-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2696005599</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2759442505</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-21c9242a2fcdfe96299e40e9f9ba62cf056e16088e853fa916c756e0ef88c3393</originalsourceid><addsrcrecordid>eNp9kcuKFDEUhoMoTjv6Ai4k4GZcRHOppCrLob1igxuF2YVM6kTSViVlklrM68yTmrLHEVy4Cvz5zncO_Ag9Z_Q1o7R_UyjtWE8o54TKXkmiH6Ad64QkPeVXD9GO9pyRQfCrM_SklCNtvJDsMToTctBK9cMO3e6nEIOzE3ZpXmwOJUWcPJ5tXFto44gnWyATt9aG5AgtrWuMMGGfMg6xZltqTvNGhy04gquhWULEHuaaCrh0r7GlhFJhxCPA0vQVcmiayc4wTTbjH5BtTUuD6w2-eHt5-PzqKXrk7VTg2d17jr69f_d1_5Ecvnz4tL88ECeorIQzp3nHLfdu9KAV1xo6Ctrra6u481QqYIoOAwxSeKuZcn2LKPhhcEJocY4uTt4lp58rlGrmUNx2VoS0FsOVVpRKqTf05T_oMa05tusM76XuOi6pbBQ_US6nUjJ4s-Qw23xjGDVbg-bUoGkNmt8Nmk394k69Xs8w3o_8qawB4gSU9hW_Q_67-z_aX0aqqX4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2759442505</pqid></control><display><type>article</type><title>Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK)</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Malyugin, Boris E. ; Belodedova, Alexandra ; Antonova, Olga ; Gelyastanov, Aslan ; Tuuminen, Raimo ; Levinger, Eliya ; Achiron, Asaf ; Knyazer, Boris</creator><creatorcontrib>Malyugin, Boris E. ; Belodedova, Alexandra ; Antonova, Olga ; Gelyastanov, Aslan ; Tuuminen, Raimo ; Levinger, Eliya ; Achiron, Asaf ; Knyazer, Boris</creatorcontrib><description>Purpose
The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet’s membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography.
Materials and methods
A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group).
Results
In the full FS-DALK group, the BB’s formation was significantly higher (64.3% vs. 36.4%,
p
= 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min,
p
= 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%,
p
= 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%,
p
< 0.001 for both comparisons).
Conclusions
Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time.</description><identifier>ISSN: 0721-832X</identifier><identifier>EISSN: 1435-702X</identifier><identifier>DOI: 10.1007/s00417-022-05765-9</identifier><identifier>PMID: 35896678</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acuity ; Cell density ; Cornea ; Cornea - surgery ; Corneal transplantation ; Corneal Transplantation - methods ; Endothelial cells ; Eye surgery ; Humans ; Injection ; Keratoconus ; Keratoconus - diagnosis ; Keratoconus - surgery ; Keratoplasty, Penetrating - methods ; Lasers ; Medicine ; Medicine & Public Health ; Ophthalmology ; Retrospective Studies ; Software ; Statistical analysis</subject><ispartof>Graefe's archive for clinical and experimental ophthalmology, 2023, Vol.261 (1), p.185-191</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-21c9242a2fcdfe96299e40e9f9ba62cf056e16088e853fa916c756e0ef88c3393</citedby><cites>FETCH-LOGICAL-c305t-21c9242a2fcdfe96299e40e9f9ba62cf056e16088e853fa916c756e0ef88c3393</cites><orcidid>0000-0001-6315-6908</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00417-022-05765-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00417-022-05765-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35896678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malyugin, Boris E.</creatorcontrib><creatorcontrib>Belodedova, Alexandra</creatorcontrib><creatorcontrib>Antonova, Olga</creatorcontrib><creatorcontrib>Gelyastanov, Aslan</creatorcontrib><creatorcontrib>Tuuminen, Raimo</creatorcontrib><creatorcontrib>Levinger, Eliya</creatorcontrib><creatorcontrib>Achiron, Asaf</creatorcontrib><creatorcontrib>Knyazer, Boris</creatorcontrib><title>Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK)</title><title>Graefe's archive for clinical and experimental ophthalmology</title><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><description>Purpose
The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet’s membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography.
Materials and methods
A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group).
Results
In the full FS-DALK group, the BB’s formation was significantly higher (64.3% vs. 36.4%,
p
= 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min,
p
= 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%,
p
= 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%,
p
< 0.001 for both comparisons).
Conclusions
Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time.</description><subject>Acuity</subject><subject>Cell density</subject><subject>Cornea</subject><subject>Cornea - surgery</subject><subject>Corneal transplantation</subject><subject>Corneal Transplantation - methods</subject><subject>Endothelial cells</subject><subject>Eye surgery</subject><subject>Humans</subject><subject>Injection</subject><subject>Keratoconus</subject><subject>Keratoconus - diagnosis</subject><subject>Keratoconus - surgery</subject><subject>Keratoplasty, Penetrating - methods</subject><subject>Lasers</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Ophthalmology</subject><subject>Retrospective Studies</subject><subject>Software</subject><subject>Statistical analysis</subject><issn>0721-832X</issn><issn>1435-702X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kcuKFDEUhoMoTjv6Ai4k4GZcRHOppCrLob1igxuF2YVM6kTSViVlklrM68yTmrLHEVy4Cvz5zncO_Ag9Z_Q1o7R_UyjtWE8o54TKXkmiH6Ad64QkPeVXD9GO9pyRQfCrM_SklCNtvJDsMToTctBK9cMO3e6nEIOzE3ZpXmwOJUWcPJ5tXFto44gnWyATt9aG5AgtrWuMMGGfMg6xZltqTvNGhy04gquhWULEHuaaCrh0r7GlhFJhxCPA0vQVcmiayc4wTTbjH5BtTUuD6w2-eHt5-PzqKXrk7VTg2d17jr69f_d1_5Ecvnz4tL88ECeorIQzp3nHLfdu9KAV1xo6Ctrra6u481QqYIoOAwxSeKuZcn2LKPhhcEJocY4uTt4lp58rlGrmUNx2VoS0FsOVVpRKqTf05T_oMa05tusM76XuOi6pbBQ_US6nUjJ4s-Qw23xjGDVbg-bUoGkNmt8Nmk394k69Xs8w3o_8qawB4gSU9hW_Q_67-z_aX0aqqX4</recordid><startdate>2023</startdate><enddate>2023</enddate><creator>Malyugin, Boris E.</creator><creator>Belodedova, Alexandra</creator><creator>Antonova, Olga</creator><creator>Gelyastanov, Aslan</creator><creator>Tuuminen, Raimo</creator><creator>Levinger, Eliya</creator><creator>Achiron, Asaf</creator><creator>Knyazer, Boris</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</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>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6315-6908</orcidid></search><sort><creationdate>2023</creationdate><title>Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK)</title><author>Malyugin, Boris E. ; Belodedova, Alexandra ; Antonova, Olga ; Gelyastanov, Aslan ; Tuuminen, Raimo ; Levinger, Eliya ; Achiron, Asaf ; Knyazer, Boris</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-21c9242a2fcdfe96299e40e9f9ba62cf056e16088e853fa916c756e0ef88c3393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acuity</topic><topic>Cell density</topic><topic>Cornea</topic><topic>Cornea - surgery</topic><topic>Corneal transplantation</topic><topic>Corneal Transplantation - methods</topic><topic>Endothelial cells</topic><topic>Eye surgery</topic><topic>Humans</topic><topic>Injection</topic><topic>Keratoconus</topic><topic>Keratoconus - diagnosis</topic><topic>Keratoconus - surgery</topic><topic>Keratoplasty, Penetrating - methods</topic><topic>Lasers</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Ophthalmology</topic><topic>Retrospective Studies</topic><topic>Software</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malyugin, Boris E.</creatorcontrib><creatorcontrib>Belodedova, Alexandra</creatorcontrib><creatorcontrib>Antonova, Olga</creatorcontrib><creatorcontrib>Gelyastanov, Aslan</creatorcontrib><creatorcontrib>Tuuminen, Raimo</creatorcontrib><creatorcontrib>Levinger, Eliya</creatorcontrib><creatorcontrib>Achiron, Asaf</creatorcontrib><creatorcontrib>Knyazer, Boris</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 Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malyugin, Boris E.</au><au>Belodedova, Alexandra</au><au>Antonova, Olga</au><au>Gelyastanov, Aslan</au><au>Tuuminen, Raimo</au><au>Levinger, Eliya</au><au>Achiron, Asaf</au><au>Knyazer, Boris</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK)</atitle><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle><stitle>Graefes Arch Clin Exp Ophthalmol</stitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><date>2023</date><risdate>2023</risdate><volume>261</volume><issue>1</issue><spage>185</spage><epage>191</epage><pages>185-191</pages><issn>0721-832X</issn><eissn>1435-702X</eissn><abstract>Purpose
The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet’s membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography.
Materials and methods
A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group).
Results
In the full FS-DALK group, the BB’s formation was significantly higher (64.3% vs. 36.4%,
p
= 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min,
p
= 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%,
p
= 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%,
p
< 0.001 for both comparisons).
Conclusions
Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35896678</pmid><doi>10.1007/s00417-022-05765-9</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6315-6908</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0721-832X |
| ispartof | Graefe's archive for clinical and experimental ophthalmology, 2023, Vol.261 (1), p.185-191 |
| issn | 0721-832X 1435-702X |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Acuity Cell density Cornea Cornea - surgery Corneal transplantation Corneal Transplantation - methods Endothelial cells Eye surgery Humans Injection Keratoconus Keratoconus - diagnosis Keratoconus - surgery Keratoplasty, Penetrating - methods Lasers Medicine Medicine & Public Health Ophthalmology Retrospective Studies Software Statistical analysis |
| title | Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK) |
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