Updates on femtosecond laser keratoplasty

Marjan Farid, MD, discussed the latest updates in femtosecond laser keratoplasty during a presentation at the American Academy of Ophthalmology’s 2022 annual meeting in Chicago. She shared the highlights of that presentation here.

Video transcript

Note: This transcript has been lightly edited for clarity.

David Hutton: I'm David Hutton of Ophthalmology Times. I'm joined today by Dr. Marjan Farid, who presented at the recent American Academy of Ophthalmology annual meeting in Chicago. Thank you for joining us today. Tell us about your presentation.

Marjan Farid, MD: Thanks for having me, David. So, my presentation at the Academy meeting and World Cornea Congress was on updates and femtosecond laser keratoplasty. And this is an innovation that came into being in around 2005 or 2006, when femtosecond lasers were first introduced to ophthalmology, and were indicated for use in LASIK and laser vision correction.

Soon after that, you know, we had some great corneal surgeons, one of them my mentor, Dr. Roger Steiner, who really looked at applying femtosecond laser technology for keratoplasty and corneal transplantation. Several iterations of customized trepanation patterns, including a mushroom pattern, a top-hat pattern and a zigzag pattern, among others, were designed to improve the wound and the wound healing in corneal transplantation.

We've now looked at several studies and outcomes in patients who have had femtosecond laser keratoplasty. And really, we've seen improvement in wound healing time, the ability to remove sutures earlier, less irregularities, torsional and vertical misalignments. And we've applied this for not only full thickness transplantation, but also for DALK or deep anterior lamellar keratoplasty, maintaining the customized trepanation pattern and its benefits with the benefits of doing a lamellar keratoplasty and minimizing things like rejection and so on.

But the next stage and all of this is really to be able to use updated and modernized femtosecond laser platforms with lower energy and higher speed to be able to make these smooth, consistent, deep lamellar cuts in the cornea. These were not possible with the earlier femtosecond laser technologies. The energy was too high and in the deep layer of the cornea, we would see too much irregularity.

But with these modern updated femtosecond laser platforms, we may be able to move this into the next stage, which is really consistent, reproducible deep lamellar cuts in the cornea, which will make DALK really a possible and really reproduceable technique in every corneal surgeon's hand and really push the boundaries and innovation in corneal surgery. And what the next stage is in all of this is to get advocacy and get a good femtosecond laser in every corneal surgeon's hand. So that's our update on femtosecond laser keratoplasty.