Femtosecond laser provides precise cut in perforating keratoplasty

Perforating keratoplasty can be performed using a femtosecond laser, according to Gerd Auffarth, MD, who described it as a "fascinating technology" at the annual meeting of the American Society of Cataract and Refractive Surgery.

Dr. Auffarth described his experience with five patients using the Femtec femtosecond laser system (20/10 Perfect Vision). The procedure required only 90 seconds to complete. In all cases the donor cornea was first cut with the Femtec laser for an 8 or 8.1 mm diameter. The recipient cornea was then lasered with a 7.8 mm diameter.

In all cases a complete perforating cut could be achieved. Tissue bridges between the cutting edges could be separated with a phaco spatula. Dr. Auffarth uses double-running Hoffmann sutures for the graft. The advantages of the procedure are that the laser provides a smooth cut on the donor and recipient tissue, the eye is closed, and there is no loss of IOP. The postoperative healing was uneventful. Dr. Auffarth is from the department of ophthalmology, Heidelberg University, Heidelberg, Germany.

The procedure can be used to treat patients with familial endothelial dystrophy, Fuch's endothelial dystrophy, keratoconus, and hereditary granular dystrophy. Patients ranged in age from 50 to 84 years.

"Perforating keratoplasty can be performed successfully with a femtosecond laser," Dr. Auffarth said. "There were no intraoperative or postoperative complications. The laser provides a precise cut.

"A consideration for the future is to form the cutting edge in such a way as to eliminate the use of sutures," he said. However, he noted that further studies of this procedure are needed.