Comparison of Penetrating Keratoplasty Performed with a Femtosecond Laser Zig-Zag Incision versus Conventional Blade Trephination

Marjan Farid, Roger F. Steinert, Ronald N. Gaster, Winston Chamberlain, Amy Lin

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate visual outcomes and astigmatism in patients who underwent penetrating keratoplasty (PK) with 2 different incision techniques. Design: Retrospective comparison of a consecutive surgical series. Participants: Fifty-seven consecutive patients who underwent PK at the University of California, Irvine, academic referral practice. Methods: A comparison of 49 eyes of 43 patients that underwent femtosecond laser zig-zag incision pattern PK versus 17 eyes of 14 patients that underwent conventional Barron suction trephination PK performed contemporaneously. All PKs were closed with an identical, 24-bite running nylon suture technique. Main Outcome Measures: Topographically determined astigmatism, best spectacle-corrected visual acuity (BSCVA), and recovery of full visual potential. Results: The postoperative follow-up ranged from 1 to 12 months. There was a significant difference in average astigmatism between the groups at postoperative month 1 (P = 0.013) and 3 (P = 0.018). By month 3, the average astigmatism was 3 diopters (D) in the zig-zag group and 4.46 D in the conventional group. Of the patients with normal macular and optic nerve function (nZZ = 32; ncon = 14), a significant difference in BSCVA was seen at month 1 (P = 0.0003) and month 3 (P = 0.006) with 81% of the zig-zag group versus 45% of the conventional group achieving BSCVA of ≥20/40 by month 3 (P = 0.03). Conclusions: The femtosecond laser generated zig-zag-shaped incision results in a more rapid recovery of BSCVA and induces less astigmatism compared with conventional blade trephination PK. Financial Disclosure(s): Proprietary commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)1638-1643
Number of pages6
JournalOphthalmology
Volume116
Issue number9
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Trephining
Penetrating Keratoplasty
Astigmatism
Lasers
Visual Acuity
Disclosure
Suture Techniques
Nylons
Suction
Bites and Stings
Optic Nerve
Referral and Consultation
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Comparison of Penetrating Keratoplasty Performed with a Femtosecond Laser Zig-Zag Incision versus Conventional Blade Trephination. / Farid, Marjan; Steinert, Roger F.; Gaster, Ronald N.; Chamberlain, Winston; Lin, Amy.

In: Ophthalmology, Vol. 116, No. 9, 09.2009, p. 1638-1643.

Research output: Contribution to journalArticle

Farid, Marjan ; Steinert, Roger F. ; Gaster, Ronald N. ; Chamberlain, Winston ; Lin, Amy. / Comparison of Penetrating Keratoplasty Performed with a Femtosecond Laser Zig-Zag Incision versus Conventional Blade Trephination. In: Ophthalmology. 2009 ; Vol. 116, No. 9. pp. 1638-1643.
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abstract = "Purpose: To evaluate visual outcomes and astigmatism in patients who underwent penetrating keratoplasty (PK) with 2 different incision techniques. Design: Retrospective comparison of a consecutive surgical series. Participants: Fifty-seven consecutive patients who underwent PK at the University of California, Irvine, academic referral practice. Methods: A comparison of 49 eyes of 43 patients that underwent femtosecond laser zig-zag incision pattern PK versus 17 eyes of 14 patients that underwent conventional Barron suction trephination PK performed contemporaneously. All PKs were closed with an identical, 24-bite running nylon suture technique. Main Outcome Measures: Topographically determined astigmatism, best spectacle-corrected visual acuity (BSCVA), and recovery of full visual potential. Results: The postoperative follow-up ranged from 1 to 12 months. There was a significant difference in average astigmatism between the groups at postoperative month 1 (P = 0.013) and 3 (P = 0.018). By month 3, the average astigmatism was 3 diopters (D) in the zig-zag group and 4.46 D in the conventional group. Of the patients with normal macular and optic nerve function (nZZ = 32; ncon = 14), a significant difference in BSCVA was seen at month 1 (P = 0.0003) and month 3 (P = 0.006) with 81{\%} of the zig-zag group versus 45{\%} of the conventional group achieving BSCVA of ≥20/40 by month 3 (P = 0.03). Conclusions: The femtosecond laser generated zig-zag-shaped incision results in a more rapid recovery of BSCVA and induces less astigmatism compared with conventional blade trephination PK. Financial Disclosure(s): Proprietary commercial disclosure may be found after the references.",
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AB - Purpose: To evaluate visual outcomes and astigmatism in patients who underwent penetrating keratoplasty (PK) with 2 different incision techniques. Design: Retrospective comparison of a consecutive surgical series. Participants: Fifty-seven consecutive patients who underwent PK at the University of California, Irvine, academic referral practice. Methods: A comparison of 49 eyes of 43 patients that underwent femtosecond laser zig-zag incision pattern PK versus 17 eyes of 14 patients that underwent conventional Barron suction trephination PK performed contemporaneously. All PKs were closed with an identical, 24-bite running nylon suture technique. Main Outcome Measures: Topographically determined astigmatism, best spectacle-corrected visual acuity (BSCVA), and recovery of full visual potential. Results: The postoperative follow-up ranged from 1 to 12 months. There was a significant difference in average astigmatism between the groups at postoperative month 1 (P = 0.013) and 3 (P = 0.018). By month 3, the average astigmatism was 3 diopters (D) in the zig-zag group and 4.46 D in the conventional group. Of the patients with normal macular and optic nerve function (nZZ = 32; ncon = 14), a significant difference in BSCVA was seen at month 1 (P = 0.0003) and month 3 (P = 0.006) with 81% of the zig-zag group versus 45% of the conventional group achieving BSCVA of ≥20/40 by month 3 (P = 0.03). Conclusions: The femtosecond laser generated zig-zag-shaped incision results in a more rapid recovery of BSCVA and induces less astigmatism compared with conventional blade trephination PK. Financial Disclosure(s): Proprietary commercial disclosure may be found after the references.

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