Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism.

We describe the technique of femtosecond-assisted astigmatic keratotomy (AK) in a post-keratoplasty patient with irregular, nonorthogonal astigmatism. Using the keratoplasty software, an anterior arcuate side cut (400 mum thick, 6.5 mm diameter) was created using the femtosecond laser in a 68-year-old woman with irregular astigmatism 28 years after penetrating keratoplasty for keratoconus. No intraoperative or postoperative adverse events were seen during the follow-up period. Six months after the procedure, the uncorrected visual acuity improved from 20/60 to 20/50 and the best spectacle-corrected visual acuity, from 20/50 to 20/32. The mean manifest astigmatic correction decreased from 4.00 diopters (D) to 0.50 D; corneal topography showed a significant improvement in irregular astigmatism. The technique of femtosecond-assisted AK is simple and efficient for managing irregular and nonorthogonal astigmatism in post-keratoplasty patients and may overcome the limitations of earlier techniques

Epithelial breakthrough during IntraLase flap creation for laser in situ keratomileusis.

We report the clinical manifestations and outcomes in 4 patients who experienced premature gas-bubble leakage during raster lamellar dissection during IntraLase femtosecond laser corneal flap creation. Three patients experienced a full-thickness epithelial breakthrough and the fourth, a flap tear. The patient who experienced the flap tear was unable to have laser in situ keratomileusis successfully. The flap complications did not result in a decreased best corrected visual acuity in any patient but may have resulted in epithelial ingrowth in one and a corneal scar and microstriae in another. Potential predisposing factors for epithelial breakthrough, the incidence of epithelial breakthrough, and methods for avoiding and salvaging traumatic corneal flaps are discussed

Effect of marking pens on femtosecond laser-assisted flap creation.

To compare the ease of the flap lift after central corneal marking with 2 types of marking pens after femtosecond laser-assisted flap creation in laser in situ keratomileusis. Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. Porcine eyes were prepared for flap creation with a femtosecond laser (IntraLase). The eyes were assigned to 1 of 4 groups. After the femtosecond laser treatment, the difficulty of flap lifting the 4 groups was compared. Twelve porcine eyes, 3 in each group, were evaluated. In the 2 groups in which an oil-based pen was used, the corneal flap could not be lifted. In the 2 groups in which a water-based pen was used, the corneal flap was easily lifted. Oil-based ink may reduce the ability of the femtosecond laser to penetrate the cornea. The resultant corneal flap may require aggressive manipulation to be lifted. When used to mark the center of the cornea before flap creation, water-based ink provided greater ease of corneal flap lifting than oil-based ink. Because the marking is located over the center of the pupil, any alteration of the cornea in this area from aggressive flap lifting may result in substantial visual loss. Therefore, the use of an oil-based ink to mark the central cornea must be avoided to prevent traumatic irregularities of the flap stroma

Complications of LASIK flaps made by the IntraLase 15- and 30-kHz femtosecond lasers.

To describe complications associated with femtosecond laser-assisted flap creation in LASIK surgery. The management and visual outcomes of femtosecond laser complications related to flap creation in LASIK patients are also described. All eyes that underwent LASIK with the IntraLase femtosecond laser from September 2003 to June 2006 at a university-based refractive center were included in this retrospective, noncomparative, interventional case series and IntraLase-related LASIK complications are described. All flaps were made with the 15- and 30-kHz IntraLase femtosecond laser. Included in the study were 4772 eyes, of which 44 (0.92%) eyes had direct or indirect complications due to flap creation. Thirty-two eyes had indirect complications (diffuse lamellar keratitis [DLK] and transient light sensitivity)--20 (0.42%) eyes developed DLK (stage 1 to 2) and 12 (0.25%) eyes had transient light sensitivity syndrome. Twelve (0.25%) eyes had direct femtosecond laser flap-related complications--8 (0.17%) eyes had premature breakthrough of gas through the epithelium within the flap margins, 3 (0.06%) eyes had incomplete flaps due to suction loss, and 1 (0.02%) eye had irregular flap due to previous corneal scar. Less than 1% of eyes had direct or indirect complications due to femtosecond laser flap creation. Laser in situ keratomileusis complications specifically related to the IntraLase femtosecond laser did not cause loss of best spectacle-corrected visual acuity in any eyes

One-year results and anterior segment optical coherence tomography findings of descemet stripping automated endothelial keratoplasty combined with phacoemulsification.

To report 1-year results and anterior segment optical coherence tomography findings of Descemet stripping automated endothelial keratoplasty combined with phacoemulsification in patients with cataract and Fuchs endothelial dystrophy. Twelve eyes of 11 patients with at least 1-year follow-up were retrospectively reviewed. Measured variables included best spectacle-corrected visual acuity, refractive spherical equivalent and predictability, anterior corneal keratometric values, complications, and anterior segment optical coherence tomography findings. The mean follow-up was 14.33 months (range, 12-18 months). The best spectacle-corrected visual acuity was unchanged (8%) or improved (92%) in all eyes compared with the preoperative levels. A mean (SD) discrepancy between the targeted postoperative refraction and the actual postoperative spherical equivalent refraction (hyperopic shift) of 1.46 (0.76) diopters (D) (range, -0.05 to 3.14 D) was observed. A significant correlation existed between the ratio of central graft thickness to mean peripheral donor corneal lenticule thickness at 3 mm and induced hyperopic shift (R(2) = 0.65, P < .001). Descemet stripping automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation in patients with coexisting Fuchs endothelial dystrophy and cataract improved best spectacle-corrected visual acuity without progressive time-dependent complications. A correlation exists between donor corneal lenticule shape and induced hyperopic shift

Femtosecond laser-assisted sutureless anterior lamellar keratoplasty.

To report the technique and small case series results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty (FALK) for anterior corneal pathology. Retrospective, noncomparative, interventional case series. Twelve consecutive eyes from 12 patients with anterior corneal scarring. Femtosecond laser-assisted sutureless anterior lamellar keratoplasty. Measured parameters included femtosecond laser settings, technique, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications. Mean follow-up was 12.7 months (range, 6-24). No intraoperative complications were found. Uncorrected visual acuity (VA) improved in 7 eyes (58.3%) compared with preoperative VA. The mean difference between preoperative and postoperative UCVAs was a gain of 2.5 lines (range, unchanged-7 lines). Best-corrected VA was unchanged or improved in all eyes compared with preoperative levels. The mean difference between preoperative and postoperative BCVAs was a gain of 3.8 lines (range, unchanged-8 lines). In 2 eyes, adjuvant surgical procedures were performed (one treated with phototherapeutic keratectomy and the other with photorefractive keratectomy). Six patients (50%) developed dry eye after FALK, which improved during the follow-up period. No graft rejection, infection, or epithelial ingrowth was found in this series of patients. Femtosecond laser-assisted sutureless anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology