There are two new codes for femtosecond laserassisted keratoplasty. Oct 05, 20 femtosecond laser was used to replace scar tissue located in anterior corneal stroma with healthy donor tissue. Purpose to evaluate wound strength for patient safety during transport and endothelial viability when partial and complete femtosecond laser assisted keratoplasty flak incisions are made in cadaveric corneas. Femtosecond laserassisted anterior lamellar keratoplasty for the. Femtosecond laser fsl incisions are more accurate and precise in arc length, diameter, depth, and curvature. Clinical outcomes of penetrating keratoplasty performed.
We utilized a modified intralase that allows up to 1,400. Epikeratoplasty definition of epikeratoplasty by medical. Cataract surgery after penetratingkeratoplasty pkp is often challenging due to changes in the integrity of the cornea caused by pkp. The femtosecond laser is widely used to perform laser in situ keratomileusis lasik 1 and penetrating keratoplasty pkp.
Pdf femtosecond laser assisted lamellar keratoplasties. Gerrit melles first introduced the posterior lamellar keratoplasty technique in 1998. The use of the femtosecond laser in penetrating keratoplasty buratto, lucio. These burns cause a ring of constriction on the peripheral cornea causing the cornea to steepen making the eye focus better at near. Femtosecond laser dalk fsdalk watch medical director sheraz daya performing a deep anterior lamellar keratoplasty using the femtosecond laser. Femtosecond laser top hat penetrating keratoplasty. Korrektur des astigmatismus nach hornhauttransplantation durch. For example, corneal endothelial cell cec loss and corneal edema commonly occur after traditional phacoemulsification cataract surgery in patients that previously had successful pkp. The intralase femtosecond laser provides surgeons with the ability to make very precise incisions in the cornea and these can be combined in a multitude of ways to enhance penetrating keratoplasty or full thickness graft surgery.
Methods 19 human corneoscleral rims were divided into six groups, mounted on an anterior chamber maintainer and cut with a femtosecond laser programmed to the following patterns. Femtosecond assisted anterior lamellar keratoplasty. Department of health and human services national institutes of health. The use of the femtosecond laser in penetrating keratoplasty. Perforierende keratoplastik bei fortgeschrittenem keratokonusvom. Penetrating keratoplasty using femtosecond laserenabled. Geuder is one of the leading manufacturers for ophthalmic surgical instruments, devices and ultrapure biomaterials. Laservision clinical and research institute, athens, greece. This groundbreaking laser system employs highperformance femtosecond laser technology and is characterized by its cutting precision, speed and gentle treatment technique. Femtosecond laser enabled keratoplasty for advanced keratoconus. Ths treats diseases like fuchs dystrophy, pseudophakic bullous keratopathy, and edema. Femtosecond laser assisted keratoplasty full text view. Preoperative and postoperative manifest refraction, uncorrected. This nonrandomised prospective study included 94 eyes.
Top hatshaped penetrating keratoplasty using the femtosecond laser top hatshaped penetrating keratoplasty using the femtosecond laser steinert, roger f ignacio, teresa s sarayba, melvin a. Moreover, the femtolaser technology, allowing to perform precise corneal cuts with a planned and customized shape, offers clear advantages also applied in anterior lamellar. Deep lamellar anterior keratoplasty dalk is a surgical technique which allows the removal of the external layers of the cornea preserving the. Billing guide overview on november 16, 2012 the centers for medicare and medicaid services cms released a guidance. To assess the efficacy and advantages of femtosecond laser enabled keratoplasty flek over conventional. The evolution of corneal and refractive surgery with the. Download fulltext pdf in vivo effects of femtosecond laserassisted keratoplasty article pdf available in jama ophthalmology 211 july 2014 with 32 reads. To evaluate a new technique for penetrating keratoplasty pk with the use of a new software algorithm for a femtosecond laser that is designed to create penetrating cuts for pk in the treatment of a number of corneal diseases. Effortless lamellar dissection through the scar tissue using z6. Lamellar keratoplasty is an effective method of restoring the integrity of the eye ravaged by corneal melting. Among them, no thermal injury, the ability to cut deeply on a single plane and to perform various corneal profiles should be mentioned. With the keratoplasty option, the zeiss visumax covers corneal transplant procedures including lamellar and penetrating keratoplasty. Refractive outcome of keratoconus treated by bigbubble deep.
May 3, 2005 use of a femtosecond laser system fls in atiol cataract surgery. To study the astigmatic correction of high postkeratoplasty astigmatism. It is a retrospective comparative surgical case series of 116 keratoconus patients 7 eyes who had pkp at the cornea eye institute, beverly hills, california, usa. The purpose of the study is to report the visual, refractive, and wound healing pattern outcomes of femtosecond assisted deep anterior lamellar keratoplasty dalk compared to the conventional manual technique. Mar 16, 2020 an endothelial keratoplasty is an eye operation in which the innermost layer, or endothelium, of the cornea is removed and replaced by donor tissue.
This creates a tight band around the eye which steepens the angle of the cornea and serves to make the eye more shortsighted, correcting the long. Femtosecond laser assisted keratoplasty flak the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This groundbreaking laser system employs highperformance femtosecond laser technology and is characterized by its outstanding cutting precision, unsurpassed speed and gentle treatment technique. Outcomes of femtosecond laserassisted mushroomconfiguration. Deep anterior lamellar keratoplasty dalk replaces the anterior 90% of diseased cornea. Laser thermal keratoplasty, or ltk, is a type of eye surgery which was introduced in the 1990s to treat longsightedness.
Precisely controlled side cut in femtosecond laserassisted deep lamellar keratoplasty for advanced keratoconus. When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Refractive surgery radial keratotomy photorefractive keratectomy prk laser insitu keratomileusis. Penetrating keratoplasty using femtosecond laser penetrating keratoplasty using femtosecond laser holzer, mike p rabsilber, tanja m auffarth, gerd u.
Endothelial cell density and corneal graft thickness following. Femtosecond laser and post keratoplasty astigmatism. By applying the femtosecond laser, we may be able to perform lamellar keratoplasty more easily and rapidly while reducing corneal perforation and interface scarring risk. With the visumax from zeiss, zeiss is significantly shaping the world of refractive surgery. Visumax combines excellent precision with bestinclass speed and treatment comfort in performing advanced femtosecond laser applications as flap, keratoplasty, incision for icr and relex the step towards minimally invasive laser vision correction. The concept of lamellar keratoplasty lk is th at of targeted lamellar replacement of corneal. Reduction of astigmatism by arcuate incisions using the femtosecond laser after corneal transplantationl.
Pdf purpose to assess the clinical outcomes of femtosecond laserassisted keratoplasty flak using. Time course of corneal astigmatism after femtosecond laser assisted keratoplasty flak and conventional. To evaluate the longterm outcomes after femtosecond laser fslassisted mushroomconfiguration keratoplasty in advanced keratoconus. Onestage femtolaser assisted lamellar keratoplasty and foreign body removal. The patients corneal epithelium is removed and a donors corneal disc or lenticule that was previously frozen and reshaped to produce a new anterior curvature is rehydrated and sutured to bowmans membrane. The most important advantage of femtolaser cataract technology at present is that all the important surgical steps of.
It enables smooth lamellar and circular incisions for penetrating keratoplasty pkp, deep anterior lamellar keratoplasty dalk and descemets stripping endothelial keratoplasty dsek. Pdf purpose to evaluate femtosecond laser in dsaek surgery as an improvement to manual dsaek. Dalk is indicated for diseases like keratoconus or deep scarring. Visual rehabilitation in combined surgical procedures. The procedure involves using the heat from a laser to shrink a ring of tissue on the cornea, the eyes transparent covering. In addition, studies of femtosecond laserenabled keratoplasty flek have shown rapid visual recovery and astigmatism comparable with or often better than traditional blade trephination. Keratoplasty with a novel approach gerald schmidinger, md, medical university of vienna, austria low energy femtolaser cataract surgery. B luecross blueshield of tennessee medical policy manual endothelial keratoplasty. Femtosecond laser was used to replace scar tissue located in anterior corneal stroma with healthy donor tissue. To assess the clinical outcomes of femtosecond laserassisted keratoplasty flak using the visumax. A noncomparative case series of 14 eyes patients with various stromal corneal diseases underwent alk with a femtosecond. Femtosecond laser settings included a bed and side cut energy of 0. Penetrating keratoplasty pk pk is a fullthickness transplant procedure, in which a trephine of an appropriate diameter is used to make a fullthickness resection of the patients cornea, followed by placement of a fullthickness donor corneal graft.
Fsl in penetrating keratoplasty penetrating keratoplasty pkp was under evolution from manual blade trephination laser assisted. The evolution of corneal and refractive surgery with the femtosecond. Although its major use at present is in the cutting of laser in situ keratomileusis flaps, the laser has proven its versatility in laserassisted anterior and posterior lamellar keratoplasty, cutting of donor buttons in endothelial keratoplasty, customized trephination in penetrating. Keratoplasty definition of keratoplasty by the free dictionary. Femtosecond laser in refractive and cataract surgeries. In addition, studies of femtosecond laser enabled keratoplasty flek have shown rapid visual recovery and astigmatism comparable with or often better than traditional blade trephination. Dalk was performed on 50 eyes of 47 advanced keratoconus patients.
List separately in addition to code for primary procedure. May 05, 2011 placement of other sutures done by interrupted sutures single running suture double running suture interrupted sutures recommended in infants and children, highly vascularized corneas and therapeutic keratoplasty knots buried beneath epithelium of recipient or donor preferred in donor to reduce risk of vascularization. Backgroundaims this paper will compare the visual outcomes of two different penetrating keratoplasty pkp techniques in patients with keratoconus. Femtosecond laser versus manual dissection for top hat. Jun 24, 2017 recent studies have reported that femtosecond laser assisted cataract surgery flacs significantly reduces the need for ultrasound energy minimizing mechanical damage to the cornea and results in a reduction of cec loss and corneal edema. The procedure employs a holmium laser to place a ring of concentric laser burns on the cornea between 6 mm and 7 mm in diameter. Femtosecondassisted astigmatic keratotomy crst europe. Femtosecond laserassisted cataract surgery after penetrating. The purpose of this study is to compare the outcomes following femtosecond laserassisted deep anterior lamellar keratoplasty dalk with 75% of stromal.
The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. The femtosecond laser has been utilized experimentally in preparation of donor tissue for endothelial keratoplasty as well as in vivorabbit models. Indications for cornea transplantation included keratoconus 19, pellucid marginal degeneration two, keratoconus. Treatment of postoperative keratoplasty astigmatism using. Reallife stories bojan pajic, md, phd, orasis ag, reinach, switzerland energy is key jod mehta, md, head of the corneal and external eye disease service of the singapore national eye center figure 2. To evaluate a new technique for penetrating keratoplasty pk with the use of a new software. Femtosecond laser assisted lamellar keratoplasties. Femtosecond laser enabled keratoplasty for advanced. Penetrating keratoplasty using femtosecond laser, american. Laboratory model of bursting pressures of femtosecond. Specific incisional width, depth and length can be programmed into the laser, allowing the incisions to be more precise. Femtosecond laser have several advantages that provide additional surgical benefits.
Femtosecond laser assisted anterior lamellar keratoplasty the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. View download pdf file, link opens in new window 06 dec 2016. Descements stripping endothelial keratoplasty dsek replaces the very posterior layers of the cornea. Femtosecond laser assisted lamellar keratoplasties 81 analyzing all our cases with the confocal micr oscopy analysis confoscan4, we found that this unsatisfactory visual results were mostly related to the excessive thickness of residual stromal bed 150 microns or more, resulting in a irregular stromal interface fig. Combined penetrating keratoplasty pk and cataract surgery pk triple procedure duration.
Nowadays, femtolaserssisted keratoplasty is one of most promising techniques. Keratoplasty definition of keratoplasty by medical dictionary. Femtolaser treatment of the crystalline lens may increase safety of the surgery in patients underwent deep anterior. Fs laser can be utilized in astigmatic keratotomy incisional surgery in both corneal grafts and native corneas to correct high degrees of post keratoplasty astigmatism. Deep lamellar endothelial keratoplasty dlek dlek is a variation in which only the endothelium is replaced. A surgical procedure on the cornea aimed at correcting ametropia. Femtosecond femto laser keratoplasty transplantation gpw is supported by the peel and rothwell jackson traveling fellowship and a pfizerroyal college of ophthalmologists ophthalmic fellowship. Pdf femtosecond laser enabled keratoplasty for advanced. Endothelial keratoplasty, also referred to as posterior lamellar keratoplasty, is a form of corneal transplantation in which the diseased inner layer of the cornea, the endothelium, is replaced with healthy donor tissue. Clinical outcomes of penetrating keratoplasty performed with. With the visumax femtosecond laser, zeiss is shaping the world of refractive surgery. Considering the many case series of new surgical techniques to combine the anterior and posterior segment e.
How to use the new contact lens codes and the new femto. In this report, we describe femtosecond laser assisted small incision dlek for treating patients with corneal endothelial dysfunction. Mar 24, 2016 the procedure is longer than penetrating keratoplasty but is associated with a reduced risk of rejection. A free powerpoint ppt presentation displayed as a flash slide show on id. Descemet stripping endothelial keratoplasty dsek dsek has gained widespread acceptance. Methods 56 keratoconus patients 66 eyes underwent femtosecond. The fs laser employs nearinfrared pulses to cut tissue with minimal collateral tissue damage. With accuracy, safety, and repeatability, eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures. Femtosecond laserassisted in situ keratomileusis for the correction. Femtosecond laser dalk fsdalk corneal transplants cfs. Pdf femtosecond laserassisted lamellar keratoplasty.
Femtosecond laserassisted anterior lamellar keratoplasty the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The cornea is the transparent covering of the eyeball, and this type of corneal transplantation may become necessary when diseases such as fuchs endothelial dystrophy damage the endothelium. Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue the graft. The patients were divided into two groups, 25 eyes each, depending on whether femtosecond assisted or manual dalk. Femtosecond laserassisted anterior lamellar keratoplasty. Laser thermal keratoplasty is a noncontact laser refractive surgery procedure. The femtosecond laser has enabled these newer shapes of wound construction for femtosecond laserenabled keratoplasty flek. Filing history for princeton femtolaser ltd 09827063 people for princeton femtolaser ltd 09827063 more for princeton femtolaser ltd 09827063 filter by category show filing type. Femtosecond laserassisted corneal endothelial keratoplasty flek or femtosecond and cpt codes atiol. The same lasers used for laser eye surgery have been adapted for use in corneal transplants and centre for sight has been an innovator in. The study aims to compare the impact of nonmechanical excimer laserassisted excimer and femtosecond laserassisted femto.
Femtosecond lasers in ophthalmology touchophthalmology. Cataract what you should know national eye institute. We report a case in which flacs was used in a patient with previous pkp. To assess the clinical outcomes of femtosecond laser assisted keratoplasty flak using the visumax. Vector analysis of femtosecond laserassisted arcuate keratotomy.
Lasik, in which the front of the cornea is removed, frozen, reshaped, and stitched. Comparison of femtosecond laserassisted descemetic and. Pdf clinical outcomes of penetrating keratoplasty performed with. The advent of the stateoftheart femtosecond laser technology as an ocular surgical tool offers potential for more finite control and precision in corneal surgery. Interface quality of different corneal lamellarcut depths. Listing a study does not mean it has been evaluated by the u. We have previously reported on the use of the femtosecond laser to perform top hatshaped penetrating keratoplasty pkp. Methods 56 keratoconus patients 66 eyes underwent femtosecond laser enabled. Recent studies have reported that femtosecond laserassisted cataract. Refractive keratoplasty procedures include keratomileusis laser assisted in situ keratomileusis.
Deep lamellar anterior keratoplasty dalk is a surgical technique which. Refractive keratoplasty is surgery to reshape the cornea of the eye to correct vision problems such as myopia nearsightedness and hyperopia farsightedness. To compare the outcomes of intralaseenabled top hat penetrating keratoplasty iek versus retrospective results of manual top hat penetrating keratoplasty thpkp and conventional pkp. Laboratory model of bursting pressures of femtosecond laserassisted penetrating keratoplasty wounds using novel pattern designs. Clinical relevance undertaking femtosecond laser keratoplasty in a. The femtosecond laser has enabled these newer shapes of wound construction for femtosecond laser enabled keratoplasty flek. Endothelial keratoplasty blue cross and blue shield of alabama. Pdf femtosecond laser fsl is an infrared laser with a wavelength of 1053 nm. However, the refractive outcome of femtosecond laser keratoplasty resembles that with motor trephine.