Saturday, September 13, 2008

Corneal transplants safer and more efficient with femtosecond laser


IntraLase-enabled keratoplasty (IEK) represents the biggest advance in corneal transplantation in the last 30 years, said Yaron Rabinowitz MD, speaking at the XXVI Congress of the ESCRS.

“Using the femtosecond laser to perform corneal grafts leads to quicker visual rehabilitation, faster wound healing and safer surgery. It represents an excellent and safer new treatment option for keratoconus patients who are contact lens intolerant and is the only viable option when combined with LASIK or ICL implants for patients who want to become completely independent of contact lenses,” he said.

Dr Rabinowitz, director of ophthalmology research at Cedars-Sinai Medical Centre, Los Angeles, US, told delegates that the procedure results in high patient satisfaction and is easy to learn and to perform.

He noted that the femtosecond laser-assisted approach overcomes many of the inherent drawbacks of traditional corneal transplantation techniques such as long intraoperative duration, long visual recovery and the fact that many patients are left with residual postoperative astigmatism because the donor button has been sutured by hand.

IntraLase, which received FDA approval for full thickness penetrating cuts in July 2005, allows the user to perform three different cut segments, noted Dr Rabinowitz.

Discussing some of these cut profiles in more detail, Dr Rabinowitz cited the mushroom-shaped incision, which preserves more host endothelium than the traditional trephine approach. Another variation, he said, is the top-hat-shaped incision that allows for the transplantation of large endothelial surfaces, as well as a lamellar step for stronger healing and a reduced anterior surface area that is further from the limbus, possibly reducing rejection risk.

Yet another incision profile, popularised by Roger Steinert MD, is the zig zag–shaped incision providing a smooth transition between host and donor tissue and allowing for a hermetic wound seal. This type of incision provides oblique planes of contact and may potentially improve the strength of wound healing, said Dr Rabinowitz.

“This is my preferred cut. It can be performed on a larger surface area, promotes stronger and quicker wound healing and delivers an extremely smooth graft interface,” he said.

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