Femtosecond laser-assisted lamellar procedures gaining in popularity, surgeon says

BERLIN — Femtosecond laser-assisted lamellar keratoplasty may be the future of corneal transplantation, a surgeon said here.

"In the Netherlands, the rate of [penetrating keratoplasty] has dropped from 90% to 60% in just a few years," Rudy Nuijts, MD, said during a symposium at the European Society of Cataract and Refractive Surgeons meeting.

Some of the typical femtosecond laser cuts, such as zigzag, are now applied to lamellar procedures, facilitating stromal excision and donor-recipient adherence.

Dr. Nuijts said he was one of the first surgeons to perform femtosecond laser-assisted posterior lamellar keratoplasty and to advocate the advantages of accuracy, reproducibility and endothelial preservation. "Endothelial cell damage is 3.4% after femtosecond dissection, compared to the 6.5% of manual dissection," he said.

In a study, he compared the results of femtosecond Descemet's stripping automated endothelial keratoplasty in 36 eyes with those of 40 PK eyes.

"Although visual acuity remains better with PK, astigmatism is lower with the lamellar technique. Recovery is faster, and patient comfort is better," Dr. Nuijts said, adding that the steeper learning curve of the femtosecond procedure is a disadvantage for the surgeon.

From my own personal experience, this is very compelling and very important in the overall learning and struggling with this whole issue of lamellar procedures and the impact on visual acuity. So, this is great data. … It showed the big bubble type of Descemet’s separation maybe has passed that final barrier to good acuity.

– Roger F. Steinert, MD
OSN U.S. Edition Cornea/External Disease Section Editor