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Femtosecond PK shows promise but offers no clear clinical advantages, speaker says
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PHILADELPHIA - Despite anecdotal reports and some data, there is no conclusive long-term proof that femtosecond laser penetrating keratoplasty surpasses the conventional method, a speaker said here.
"The take-home message here is that we're still looking to see if, in fact, there are ways we can refine the femtosecond procedure to make it advantageous enough that we're all going to run out and spend $500,000 on a laser that you can use instead of a handheld trephine. I think, though, this is an exciting thing," Irving M. Raber, MD, said at the Wills Eye Institute Alumni Conference.
The femtosecond laser enables customized wound designs such as the zigzag and top hat configurations, which speed wound healing and visual recovery. Disadvantages include cost, the need for additional staff, the need to move patients from a laser center to an operating room, and difficult centration.
Dr. Raber cited a study showing that femtosecond laser PK offered faster visual recovery and slightly better uncorrected and best corrected visual acuity at 3 months but no difference in visual acuity at 12 months. Data showed no difference in cylinder at any time.
Another study showed that while femtosecond PK yielded less residual astigmatism than the conventional method at 4 to 6 months, it did not offer superior BCVA at any time.
"What I like about the femtosecond laser ... is that it allows you to do lamellar keratoplasty, where you get nice, smoother beds than you would with the handheld trephine," he said.
- Disclosure: Dr. Raber reported no relevant financial relationships.
Dr. Raber correctly summarized the advantages and disadvantages of femtosecond PK. The femto laser precisely creates complex corneal incisions that can facilitate faster healing and allow earlier suture removal, as recently reported in the March issue of Ophthalmology. We have found that laser PK incisions are harder, if not impossible to re-open, whereas trephine-created incisions re-open easily. In particular, the zigzag incision with a tongue-in-groove shape provides a stronger wound and is an important benefit, because wound rupture with minor trauma is a lifelong concern for PK patients. However, the capital expense, per-procedure costs, along with the need to move patients between laser and surgical facilities and doubling of surgeon and staff time remain significant disadvantages.
– Marianne O. Price, PhD
Executive
Director, Cornea Research Foundation of America, Indianapolis
Disclosure:
Dr. Price has financial relationships with Abbott Medical Optics and Moria.