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IntraLase used for ‘top-hat’ corneal transplant
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A “top-hat” corneal transplant created with a femtosecond laser may heal faster, allow earlier suture removal and reduce the risk of subsequent injury, said Francis W. Price Jr., MD.
Dr. Price used the IntraLase FS laser to perform the first all-laser “top-hat” corneal graft procedure in a human, according to a statement from the Corneal Research Foundation of America.
The femtosecond laser allows the surgeon to produce “complex contours and custom designs” for each transplant patient, according to Dr. Price. The high-speed laser precisely cuts grafts to provide “faster and stronger healing compared with traditional transplant methods,” he said.
Dr. Price analyzed data on six patients who underwent corneal transplant surgery performed with the IntraLase. Indications for surgery in these patients included herpes corneal scarring, Fuchs’ dystrophy, pseudophakic bullous keratopathy and noninflammatory central scarring.
Contoured incisions have been discussed since the 1920s, Dr. Price said, but have never gained acceptance because the techniques were too cumbersome with manual dissection. The IntraLase is able to recreate the incision profile the surgeon desires, he said.
The top-hat procedure is so named because the donor button is shaped with a lip of tissue, like the brim of a top hat. The recipient bed is also shaped by the laser to accommodate the lip, which helps hold the graft in place.
“The key will be to determine which incision size and shapes are optimal for treating different indications. Currently the emphasis is on making top-hat or mushroom-shaped incisions so that the inner surface of the graft is larger than the external surface,” Dr. Price said.