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Femtosecond lasers revolutionizing cornea transplant surgery

Arguably the most significant advance in corneal transplant surgery since the surgical microscope will soon be available to ophthalmologists worldwide.

ByMichael A. Lawless, MD

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Michael A. Lawless

The possibility that femtosecond lasers could create a new standard in corneal transplantation has been mooted for many years. IntraLase has developed what it terms “Intra Lase Enabled Keratoplasty,” or IEK, with the expectation that it would minimize post corneal transplant astigmatism and provide faster visual recovery with enhanced wound stability.

The femtosecond laser enables different wound configurations for specific corneal diseases. For example, a top hat-shaped keratoplasty wound would be best for those with endothelial disease, as it provides a large area endothelial surface transplantation; a mushroom-shaped keratoplasty for those with anterior corneal disease preserves more host endothelium. There is even the possibility of a zigzag-shaped wound to provide a smoother transition between host and donor and a hermetic wound seal. The zigzag-shaped incision seems to create a smooth corneal contour immediately after surgery with less induction of regular and irregular astigmatism.

IEK is in its early days, with only about 80 patients treated worldwide so far in the United States and Mexico.

It is estimated that in the United States there will be approximately 45,000 penetrating keratoplasties performed in 2006, with a worldwide total of approximately 105,000.

This will be a most interesting time for the profession, as IntraLase femtosecond lasers are located predominantly in refractive surgery centers. Corneal transplantation is normally performed in conventional operating theatres, largely by ophthalmologists with a subspecialty interest.

The challenges would seem to be:

1. Demonstrating that the precision and novel approaches to wound construction possible with IEK will improve the safety and efficacy of corneal transplantation.
2. Building a link between those refractive surgeons who either own or have the technical experience with IntraLase and those ophthalmologists who have experience in corneal transplantation.
3. Private health insurance and governments determining whether this is a worthwhile treatment to subsidize, as they would for other therapeutic eye surgeries.

What a challenge for ophthalmology to bring together precision technology, the skills of refractive surgeons and the skills of corneal transplant surgeons, and what may prove to be substantially better outcomes for corneal transplant recipients.

For more information:

• Michael A. Lawless, MD, can be reached at Eye Institute, 270 Victoria Ave., Chatswood, NSW 2067 Australia; +61-29-424-9999; fax: +61-29-410-3000; e-mail: mlawless@theeyeinstitute.com.au. Dr. Lawless is a member of Alcon’s medical advisory board.