"We have more rapid wound healing, we have stronger wounds, and we're able to match up the donor and the recipient more accurately than we've ever been able to do with any type of metal blade," said Francis W. Price Jr., MD, an Indianapolis clinician who late last year was the first surgeon in the United States to perform cases with a prototype of the modified laser.
Only a few ophthalmologists in the United States and other countries have performed keratoplasties with the new femtosecond laser, using either a prototype or the newly released upgrade, but they are enthusiastic about the technology. Several of them described their experiences with the new technique in presentations at the XXIV Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) in London, where the system upgrade officially was launched.
"Those of us who have done this feel that this is the first major advance in corneal transplantation for at least the past 35 to 40 years," said Roger F. Steinert, MD, professor of ophthalmology and biomedical engineering at the University of California, Irvine (UC Irvine). The procedure is referred to as either femtosecond laser-enabled keratoplasty or IntraLase-enabled keratoplasty.
The first corneal transplant was performed in 1905, and published reports of hand-shaped wound configuration for penetrating keratoplasty appeared between 1950 and 1960. Other physicians have worked with the shaped incisions more recently, continuing to pursue the concept because of its potential for earlier, stronger wound healing and faster rehabilitation due to the greater surface area for attachment or binding and a natural seal created by the shaped edges.
With the arrival of the upgraded femtosecond laser, the technology is finally available to achieve those objectives more efficiently.
"This changes the whole waterfront," said Dr. Steinert. "When you see these cases and you see how they heal, it's so demonstrably different and it's so easy to do that we feel really excited by it. We're fairly convinced that this is going to become commonplace over the next couple of years. It's revolutionary, and it's going to have a huge positive impact on our patients."
The surgeon's dream
"It's been the surgeon's dream that we could have some instrument that could precisely shape the edges of these corneal transplants for better healing, and the IntraLase femtosecond laser brings about that possibility," said William Culbertson, MD, professor of ophthalmology at the Bascom Palmer Eye Institute, University of Miami School of Medicine, who tested a prototype earlier this year. He predicted that within 5 years, 75% of corneal surgery in technologically advanced countries would be performed with this laser.