A new surgical technique: a femtosecond laser-assisted keratolimbal allograft procedure.

PURPOSE: To evaluate the feasibility of a femtosecond (FS) laser-assisted keratolimbal allograft (KLAL) technique. DESIGN: Interventional case series. METHODS: This study included 3 patients with extensive limbal stem cell deficiency. The donor cornea was dissected with an FS laser (IntraLase FS laser, 60 kHz) using a ring procedure, without outer side cutting for the limbal graft, after a penetrated dissection of the donor cornea prior to penetrating keratoplasty (PKP). The depth and width of the ring procedure were adjusted for each individual patient. Further extension to the periphery of the sclerocorneal tissue of the donor graft was performed with a diamond knife. In a case of KLAL alone, the unhealthy limbal tissue of the recipient was removed with the FS laser by the same method employed in donor preparation. One patient underwent KLAL alone, and 2 patients underwent KLAL combined with PKP. The patients were followed up for a maximum of 10 months. RESULTS: Limbal grafts were even and thin, as expected. The case with KLAL alone showed the fastest epithelization of the recipient cornea. The 2 cases of combined KLAL and PKP showed excellent approximation between recipient and donor tissue. The ocular surfaces have been stable for 8 months in case 1 and 10 months in cases 2 and 3. CONCLUSION: FS laser-assisted KLAL has potential advantages in terms of simplicity and speed as compared with conventional techniques.

A novel technique: eccentric lamellar keratolimbal allografting using a femtosecond laser.

PURPOSE: To report on a patient who received an eccentrically designed lamellar keratolimbal allograft prepared using a femtosecond (FS) laser to preserve peripheral curvature. METHODS: A 19-year-old woman, with a pseudopterygium on the left eye resulting from dermoid excision about 11 years earlier, received an eccentric lamellar keratolimbal allograft in a procedure involving FS laser use. Corneal flaps of depths 280 and 400 mum and diameters 6.5 and 6.6 mm were eccentrically created by FS laser treatment of the recipient and donor eyes, respectively, after removal of the pseudopterygium. After amniotic membrane transplantation, the eccentrically designed corneal flap was secured with 10-0 nylon sutures. RESULTS: Corneal flap creation was uneventful. Only minimal suturing was required for lamellar keratoplasty, and no complications occurred. Twelve months after surgery, a stable corneal surface was observed, with minimal scar formation at the graft margin and relatively good graft interface clarity. CONCLUSION: Eccentric lamellar keratolimbal allografting using an FS laser is an effective and time-saving surgical method to treat peripheral corneal abnormalities featuring corneal opacity.

Femtosecond laser lamellar keratoplasty to aid visualization for cataract surgery.

PURPOSE: To describe a new surgical technique for a patient with cataract combined with corneal opacity. METHODS: This technique, femtosecond laser-assisted cataract surgery, was performed on a patient with a history of corneal opacity in both eyes from childhood. Because the patient had deep stromal corneal opacity, a corneal button 400-mum thick was made for lamellar keratoplasty while cataract surgery was performed simultaneously. RESULTS: Lifting of the flap and removal of the corneal button before cataract surgery was successful without any intraoperative complications. CONCLUSIONS: Femtosecond laser-assisted cataract surgery is a promising surgical procedure for a cataract patient with stromal corneal opacity.

Creation of an extremely thin flap using IntraLase femtosecond laser.

A 43-year-old woman had laser in situ keratomileusis (LASIK) using the IntraLase femtosecond laser (IntraLASIK) to create 110 microm flaps. Despite uneventful flap formation, the flaps in both eyes were extremely thin, making it difficult to lift them. The flap in the right eye resembled an epi-LASIK epithelial flap. It was lifted uneventfully. The flap in the left eye was stretched and torn on lifting, and the procedure was therefore postponed. After 6 months, the IntraLASIK surgical procedure was repeated in the left eye using a thicker and smaller flap than in the first procedure. Despite the improvements associated with using an IntraLase femtosecond laser, thinner-than-intended corneal flaps can occur. Early recognition of such a flap can prevent further complications.

The analysis of predicted capsular bag diameter using modified model of capsule measuring ring in Asians.

BACKGROUND: This study measured the capsular bag diameter (CBD) of Asian eyes using a modified capsular measuring ring (CMR) after cataract surgery, and identified preoperative predictive factors for postoperative CBD and the change of capsular bag diameter after surgery. METHODS: This prospective study followed 25 eyes undergoing cataract surgery inserted with a CMR before intraocular lens (IOL) implantation at the Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Republic of Korea. Axial length (AL), anterior chamber depth (ACD), lens thickness, corneal power and corneal size were measured preoperatively. CBD was calculated using the CMR in a dilated state at postoperative 1 day, 1 week, 1 month, 2 months, and 1 year. RESULTS: AL (R = 0.713) and ACD (R = 0.402) were found to positively correlate with CBD at postoperative 1 week. AL (P < 0.001) and ACD (P = 0.046) were found to be predictors of CBD. The mean CBD gradually decreased to 11.30 +/- 1.76 mm at 1 day, 10.86 +/- 1.06 mm at 1 week, 10.23 +/- 1.43 mm at 1 month, 9.88 +/- 1.31 mm at 2 months, and 9.85 +/- 1.43 mm at 1 year. CONCLUSION: CBD size could be determined using a CMR implanted during surgery. AL and ACD were predictors of postoperative CBD. Predicting CBD in this way may assist in selecting appropriately sized IOL, which will lead to improved visual quality after cataract surgery.

Novel technique of corneal biopsy by using a femtosecond laser in infectious ulcers.

PURPOSE: To describe femtosecond laser-assisted corneal biopsy and its use in assessing the causative organisms in 2 cases of infectious corneal ulcers. METHODS: A 27-year-old man and a 65-year-old woman, both of whom showed uncertain symptoms, repeated negative test results for infectious organisms, and after no improvement despite empirical therapy, underwent diagnostic corneal biopsy by using a femtosecond laser. A corneal flap depth of 200 microm and a diameter of 3 mm were obtained from each patient. RESULTS: The biopsy specimen from the male patient showed pseudohyphae, which led to a diagnosis of candidal keratitis. The biopsy specimen from the female patient showed positive Gram stain and no evidence of fungal ulcers and yielded a culture of Streptococcus viridans. No complications occurred during either procedure. CONCLUSIONS: Femtosecond laser-assisted corneal biopsy enabled identification of the infectious pathogen in both patients. This technique is easy, safe, and rapid, and it yields a biopsy specimen with a uniform depth and precise size. Femtosecond laser-assisted corneal biopsy can be used as an accurate diagnostic method in uncertain cases of corneal ulcers.