Review of the femtosecond laser in DALK surgery

Adeyoju, Joshua and Hossain, Parwez (2022) Review of the femtosecond laser in DALK surgery. Journal of the Foundations of Ophthalmology. (doi:10.48089/jfo7681082).

Abstract

Introduction
The femtolaser has emerged as a novel method to conduct anterior segment surgery in ophthalmology, including deep anterior lamellar keratoplasty (DALK) surgery. There are certain advantages the femtolaser may have, as compared to manual/conventional methods for DALK corneal transplant surgery.

Methods
This literature review aims to identify both observational and interventional studies within femto-DALK literature, and as such, discuss indications, surgical techniques, outcomes and scope for further research in the area. Studies were identified via thorough online database text word searching.

Results
Common indications for femto-DALK match that in conventional-DALK literature. In outcomes, the femtolaser can produce equivalent visual outcomes as seen in conventional-DALK. Some interventional studies show statistically significantly better visual outcomes than conventional-DALK. Complication rates with conventional-DALK appear to be equivalent.

Two surgical techniques, the Anwar and the Melles technique, are popular in femto-DALK. Surgical opinion in literature appears to find the Anwar technique advantageous in femto-DALK. Two graft shapes are popular in femto-DALK, a 90 degree side-cut and a mushroom shaped graft, although there is a lack of direct interventional research comparing the two.

Conclusion
There is a wealth of research within femto-DALK literature which aids the current landscape. There remains scope for further research within femto-DALK including in study design, outcomes measured, and surgical techniques assessed. As femtolaser technology continues to develop, there may be further differences observed within literature as time progresses.

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Contributors

Author: Parwez Hossain

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