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Femtosecond laser-assisted keratectomy suitable for corneal scarring

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Leela Raju

WASHINGTON — Femtosecond laser-assisted keratectomy can be an additional effective treatment for patients with corneal scarring, according to a speaker here.

“The femtosecond option is very nice. We can leave some of that epithelium intact and not induce as much inflammation and TGF-beta activation to help us make sure that we have as clear a surface as possible. It may work better for slightly deeper anterior stromal opacities, as opposed to specifically ones that affect Bowman,” Leela Raju, MD, said during Cornea Day at the American Society of Cataract and Refractive Surgery annual meeting.

Treatment options for anterior stromal scarring and PRK haze include phototherapeutic keratectomy, penetrating keratoplasty, deep anterior lamellar keratoplasty or femtosecond laser-assisted keratectomy.

Femtosecond laser-assisted keratectomy can create a planar flap instead of a meniscus flap with a microkeratome, which may help surgeons avoid a hyperopic shift.

“We can also adjust for both the depth and diameter of the corneal opacity,” Raju said.

The scar, however, may have a potential negative effect on the femtosecond laser and could lead to abnormalities such as vertical gas breakthrough. The laser may not cut through the cornea and the plane the surgeon wants, she said.

“If we can aim to reduce our hyperopic shift by having a more planar flap and we are able to see the depth of the scar by the anterior segment OCT, perhaps that will allow us to see if in the future if something with topographic-guided or a small lenticule incision procedure can help us target these kinds of scars more accurately,” Raju said. – by Robert Linnehan

Reference:

Raju L. S.O.S. Save our stroma or scarred for life. Presented at: American Society of Cataract and Refractive Surgery annual meeting; April 13-17, 2018; Washington.

Disclosure: Raju reports no relevant financial disclosures.