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Comparison of Excimer Laser Versus Femtosecond Laser Assisted Trephination in Penetrating Keratoplasty: A Retrospective Study

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Abstract

Introduction

To compare the impact of non-mechanical excimer-assisted (EXCIMER) and femtosecond laser-assisted (FEMTO) trephination on outcomes after penetrating keratoplasty (PK).

Methods

In this retrospective study, 68 eyes from 23 females and 45 males (mean age at time of surgery, 53.3 ± 19.8 years) were included. Inclusion criteria were one surgeon (BS), primary central PK, Fuchs’ dystrophy (FUCHS) or keratoconus (KC), no previous intraocular surgery, graft oversize 0.1 mm and 16-bite double running suture. Trephination was performed using a manually guided 193-nm Zeiss Meditec MEL70 excimer laser (EXCIMER group: 18 FUCHS, 17 KC) or 60-kHz IntraLase™ femtosecond laser (FEMTO group: 16 FUCHS, 17 KC). Subjective refractometry (trial glasses) and corneal topography analysis (Pentacam HR; Casia SS-1000 AS-OCT; TMS-5) were performed preoperatively, before removal of the first suture (11.4 ± 1.9 months) and after removal of the second suture (22.6 ± 3.8 months).

Results

Before suture removal, mean refractive/AS-OCT topographic astigmatism did not differ significantly between EXCIMER and FEMTO. After suture removal, mean refractive/Pentacam/AS-OCT topographic astigmatism was significantly higher in the FEMTO (6.2 ± 2.9 D/7.1 ± 3.2 D/7.4 ± 3.3 D) than in the EXCIMER patients (4.3 ± 3.0 D/4.4 ± 3.1 D/4.0 ± 2.9 D) (p ≤ 0.005). Mean corrected distance visual acuity increased from 0.22 and 0.23 preoperatively to 0.55 and 0.53 before or 0.7 and 0.6 after suture removal in the EXCIMER and FEMTO groups, respectively. Differences between EXCIMER and FEMTO were only pronounced in the KC subgroup.

Conclusion

Non-mechanical EXCIMER trephination seems to have advantages regarding postoperative corneal astigmatism and visual acuity compared with FEMTO trephination, especially in KC. A bigger sample size and longer follow-up are needed to evaluate the long-term impact of EXCIMER and FEMTO trephination on postoperative topographic and visual outcomes.

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Acknowledgements

We hereby thank all the participants of the study.

Funding

No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the University of Saarland.

Medical Writing Assistance

Language editing and assistance for this article were provided by San Francisco Edit (San Francisco, USA) and funded by the University of Saarland.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Gábor Tóth, Nóra Szentmáry, Achim Langenbucher, Elina Akhmedova, Moatasem El-Husseiny and Berthold Seitz have nothing to disclose.

Compliance with Ethics Guidelines

The study was approved by the Ethics Committee of Saarland University, Germany (no. 201/11). All procedures performed in our study involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent for participation and publication of patient data was obtained from all individual participants included in the study.

Data Availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg/Saar, Germany

    Gábor Tóth, Nóra Szentmáry, Elina Akhmedova, Moatasem El-Husseiny & Berthold Seitz

  2. Department of Ophthalmology, Semmelweis University, Mária utca 39, 1085, Budapest, Hungary

    Gábor Tóth & Nóra Szentmáry

  3. Experimental Ophthalmology, Saarland University, Kirrberger Str. 100, 66424, Homburg/Saar, Germany

    Achim Langenbucher

Authors
  1. Gábor Tóth
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  2. Nóra Szentmáry
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  3. Achim Langenbucher
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  4. Elina Akhmedova
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  5. Moatasem El-Husseiny
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  6. Berthold Seitz
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Correspondence to Gábor Tóth.

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Tóth, G., Szentmáry, N., Langenbucher, A. et al. Comparison of Excimer Laser Versus Femtosecond Laser Assisted Trephination in Penetrating Keratoplasty: A Retrospective Study. Adv Ther 36, 3471–3482 (2019). https://doi.org/10.1007/s12325-019-01120-3

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