Femtosecond laser-enabled keratoplasty 'exciting' news for corneal transplantation

Femtosecond laser-enabled keratoplasty is thought to be the biggest advance in corneal transplantation in the past 20 years, according to Yaron S. Rabinowitz, MD, chief of ophthalmology, Cedars-Sinai Medical Center, Los Angeles, United States.

"We know penetrating keratoplasty works extremely well, but there are many factors contributing to astigmatism," he said.

Femtosecond laser-enabled keratoplasty enables ophthalmologists to perform multiple cuts the entire length of the endothelium using one of three incision patterns: top hat, mushroom, or zig zag.

"You actually can get much better apposition of the wound," Dr. Rabinowitz said. "You also get much better wound healing . . . . And the advantage is, you get significant reduction of astigmatism very early on."

Data from almost every one of six studies from six different countries (Por, Singapore; Daya, United Kingdom; Burrato, Italy; Naranjo-Tackman, Mexico; Steinert, United States; and Nuijts, The Netherlands) presented at the 2007 annual meeting of the American Society of Cataract and Refractive Surgery demonstrate "significant reduction in the postoperative cylinder" with femtosecond laser-enabled keratoplasty, he said, adding that the range with conventional penetrating keratoplasty is about 4 to 25 D.

The range seen with femtosecond laser-enabled keratoplasty is "extremely narrow," Dr. Rabnowitz said. "It's very exciting news in the management not only of keratoconus but also post-LASIK ectasia."

He spoke of the surgery using a particular femtosecond laser (IntraLase FS, Advanced Medical Optics).