This article is more than 5 years old. Information may no longer be current.

Femtosecond laser could improve, innovate DALK procedure

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

Marjan Farid

SAN DIEGO — The use of femtosecond lasers could be the future of DALK with advocacy and accessibility, according to a speaker here.

“The future outlook, we think, is an integration of these technologies, OCT guidance and newer generation lasers, optimizing settings so that every cornea surgeon can perform a successful DALK every single time,” Marjan Farid, MD, said at Cornea Subspecialty Day at the ASCRS annual meeting.

The “big-bubble” technique that is commonly used in deep anterior lamellar keratoplasty (DALK) still has a high rate of failure with perforation of Descemet’s membrane as the bubble can be difficult to achieve, according to Farid. And while many surgeons have moved to using the more predictable manual dissection in the posterior lamella, a smooth, perfect cut cannot be achieved.

With a customized trephination pattern with the femtosecond laser, there can be better wound alignment, improvement in astigmatism values and better wound healing, she said.

“With the zig-zag cut there’s a lamellar dissection cut that happens at 300 mm. That lamellar dissection can be extended to remove the entire anterior two-thirds of the cornea, which will improve visibility of the posterior cornea and really guide needle insertion and air injection,” she said.

Posterior lamellar cuts have so far resulted in ridges and irregularities, but if the laser’s energy levels could be adjusted to a lower setting, it could increase the spot size and separation to create a cut that resembles those in the anterior lamella.

Along with intraoperative OCT guidance to assess all the layers of the cornea during the procedure, Farid said she is “hopeful that this is the future of DALK.”

“What we need now as a cornea society is advocacy to help bring these solutions and this technology into every hand and make accessibility better,” she said. – by Rebecca L. Forand

Reference:

Farid, M. Innovations in DALK: Femtosecond laser and OCT. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.

Disclosure: Farid reports she is a consultant for Johnson & Johnson Vision, Zeiss, Kala, Takeda, CorneaGen, Shire, EyePoint and Bio-Tissue.