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Femtolaser-assisted keratoplasty: surgical outcomes and benefits

Femtolaser-assisted keratoplasty: surgical outcomes and benefits
Femtolaser-assisted keratoplasty: surgical outcomes and benefits
Femtosecond laser technology has evolved as an alternative method to make surgical incisions in keratoplasty. The use of this approach has a number of purported advantages that may lead to superior clinical outcomes. However, there remains a low uptake of the femtolaser-assisted keratoplasty within public healthcare, and incongruity remains between perceived expert opinion on the presence and significance of superior clinical outcomes based on available data.

This review is registered publicly on the Open Science Framework registry and aims to evaluate the evidence base on femtolaser-assisted keratoplasty and its comparison with manual trephination in intraoperative and postoperative outcomes. Over 2000 studies were screened and critically appraised in the field of keratoplasty, using multiple databases. 17 studies were included via predetermined criteria for full analysis. The studies covered interventional research into penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and posterior lamellar keratoplasty (PLK).

The results of this review show that PK studies shared a trend of improved visual outcomes with the femtolaser, and evidence for earlier suture removal. Complication rates were similar. When used for DALK, studies showed some evidence of improved visual outcomes with the femtolaser, and evidence for earlier suture removal, reduced intraoperative complications and increased wound healing activity. The use in Descemet’s membrane endothelial keratoplasty (DMEK) showed reduced graft detachment whereas in Descemet’s stripping automated endothelial keratoplasty (DSAEK) the results were limited.

Overall, this review shows a trend that the use of the femtolaser may improve clinical outcomes in PK, DALK and DMEK. However, it was also clear that in order to corroborate the superiority of femtolaser-assisted keratoplasty versus manual methods, further research is required.
2452-4034
1-13
Adeyoju, Joshua
db6b40f9-614b-4b09-a8c5-a0556b214032
Konstantopoulos, Aristides
c54185a9-1ef3-4b6d-91a3-38de444cc4fb
Mehta, Jodhbir S.
16827270-158f-4f00-9810-914ad62aeb3f
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Adeyoju, Joshua
db6b40f9-614b-4b09-a8c5-a0556b214032
Konstantopoulos, Aristides
c54185a9-1ef3-4b6d-91a3-38de444cc4fb
Mehta, Jodhbir S.
16827270-158f-4f00-9810-914ad62aeb3f
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51

Adeyoju, Joshua, Konstantopoulos, Aristides, Mehta, Jodhbir S. and Hossain, Parwez (2020) Femtolaser-assisted keratoplasty: surgical outcomes and benefits. Journal of EuCornea, 8, 1-13. (doi:10.1016/j.xjec.2020.05.001).

Record type: Article

Abstract

Femtosecond laser technology has evolved as an alternative method to make surgical incisions in keratoplasty. The use of this approach has a number of purported advantages that may lead to superior clinical outcomes. However, there remains a low uptake of the femtolaser-assisted keratoplasty within public healthcare, and incongruity remains between perceived expert opinion on the presence and significance of superior clinical outcomes based on available data.

This review is registered publicly on the Open Science Framework registry and aims to evaluate the evidence base on femtolaser-assisted keratoplasty and its comparison with manual trephination in intraoperative and postoperative outcomes. Over 2000 studies were screened and critically appraised in the field of keratoplasty, using multiple databases. 17 studies were included via predetermined criteria for full analysis. The studies covered interventional research into penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and posterior lamellar keratoplasty (PLK).

The results of this review show that PK studies shared a trend of improved visual outcomes with the femtolaser, and evidence for earlier suture removal. Complication rates were similar. When used for DALK, studies showed some evidence of improved visual outcomes with the femtolaser, and evidence for earlier suture removal, reduced intraoperative complications and increased wound healing activity. The use in Descemet’s membrane endothelial keratoplasty (DMEK) showed reduced graft detachment whereas in Descemet’s stripping automated endothelial keratoplasty (DSAEK) the results were limited.

Overall, this review shows a trend that the use of the femtolaser may improve clinical outcomes in PK, DALK and DMEK. However, it was also clear that in order to corroborate the superiority of femtolaser-assisted keratoplasty versus manual methods, further research is required.

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More information

Accepted/In Press date: 16 May 2020
e-pub ahead of print date: 24 May 2020
Published date: 18 October 2020

Identifiers

Local EPrints ID: 443459
URI: http://eprints.soton.ac.uk/id/eprint/443459
ISSN: 2452-4034
PURE UUID: 40f4f7f3-84e9-4ad0-bdfd-db1fba9fa279
ORCID for Parwez Hossain: ORCID iD orcid.org/0000-0002-3131-2395

Catalogue record

Date deposited: 26 Aug 2020 16:35
Last modified: 18 Feb 2021 17:06

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