Big-bubble deep anterior lamellar keratoplasty assisted by femtosecond laser in children.

To report the early results of big-bubble deep anterior lamellar keratoplasty assisted by femtosecond laser in children. Five eyes of 5 pediatric patients were enrolled in the study; 3 had keratoconus and 2 corneal opacities. An IntraLase 60 KHz femtosecond laser (Abbott Medical Optics, Inc) was used to create mushroom incisions on both donor and recipient corneas. All patients were evaluated for best-corrected visual acuity, spherical equivalent, refractive astigmatism, keratometric astigmatism, mean K value, and corneal thinnest point. The big bubble was always achieved, and all eyes were treated successfully without intraoperative complications. The follow-up was of 10 months. At 10 months (at least 3 months after complete suture removal), the mean postoperative best-corrected visual acuity was 20/30 (range, 20/25 to 20/30), mean spherical equivalent was -1.8 ± 1.2 diopters (D) (range, -0.25 to 1.25 D), mean refractive astigmatism was 1.8 ± 1.4 D (range, 0 to 4.0 D), mean keratometric astigmatism was 5.1 ± 2.1 D (range, 3.5 to 8.59 D), mean K value was 46.2 ± 0.8D, and mean corneal thinnest point was 581 ± 46 µm (range, 511-638 µm). Our early findings suggest that the big-bubble technique in deep anterior lamellar keratoplasty assisted by femtosecond laser is safe and effective also in pediatric patients in the attempt to decrease the rejection percentage, improve the refractive outcome, and then provide an antiamblyopic effect.

Refractive outcome of keratoconus treated by combined femtosecond laser and big-bubble deep anterior lamellar keratoplasty.

PURPOSE: To report 1-year follow-up in 11 of 13 eyes with keratoconus treated by deep anterior lamellar keratoplasty with a combined femtosecond laser lamellar resection followed by a big-bubble dissection. METHODS: Thirteen eyes with keratoconus were treated. Recipient and donor were prepared with the 60-kHz IntraLase femtosecond laser (Abbott Medical Optics). In the recipient, the femtosecond laser, after performing a lamellar cut 100 µm above the thinnest corneal point (measured by Pentacam [Oculus Optikgeräte GmbH]), was used to make a mushroom-shaped resection (anterior diameter, 9 mm; posterior diameter, 8 mm) from the same depth. In the donor, the mushroom lamellar thickness was calculated according to an original model based on the recipient preoperative corneal thickness. Upon removal of the recipient lamella, air was injected into the residual stroma to achieve a big bubble. The keratectomy was continued up to Descemet membrane. The donor was fit into place and sutured using interrupted sutures, which were removed by 8 months postoperative. Corrected distance visual acuity (CDVA) and refractive astigmatism were calculated by manifest refraction, whereas topographic astigmatism and corneal thickness were measured by Pentacam. RESULTS: A big bubble was successfully achieved in 11 eyes. Twelve months after surgery, mean CDVA was 0.52±1.2 (decimal), and refractive sphere and cylinder were -1.50±1.70 diopters (D) and 2.00±2.60 D, respectively. Three (27%) of 11 eyes at 1 year had a manifest refraction spherical equivalent within 1.00 D of emmetropia. Topographic astigmatism was 2.90±1.60 D. The thinnest corneal point was 519±27 µm. CONCLUSIONS: This combination of a femtosecond laser lamellar dissection with a big-bubble technique can improve the standardization of deep anterior lamellar keratoplasty for keratoconus.