MANUAL ANTERIOR LAMELLAR KERATOPLASTY vs FEMTOSECOND LASERASSISTED TECHNIQUE: DONORRECIPIENT INTERPH

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MANUAL ANTERIOR LAMELLAR KERATOPLASTYvs
FEMTOSECOND LASER-ASSISTED TECHNIQUEDONOR-RECIP
IENT INTERPHASE CONFOCAL MICROSCOPY ANALYSIS

• RAMON NARANJO-TACKMAN,MD
• MANUEL RAMIREZ-FERNANDEZ,MD
• Cornea Refractive Surgery Department.
• Assn. to Prevent Blindness in Mexico
• Mexico City, Mexico

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CONFOCAL ANALYSIS OF THE INTERPHASE

• RATIONALE
• Lamellar Keratoplasty(LK), a technique that is
  becoming more popular every day, due to real
  advantages over PK like less endothelial
  rejection risk, among others, has now the
  advantages of a new Laser Technology The
  Femtosecond Laser.
• However a crucial point is the quality of vision,
  cornea surgeons still have to demonstrate if in
  terms of visual quality, LK wont leave patients
  with less visual quality, than PK.

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CONFOCAL ANALYSIS OF THE INTERPHASE

• The purpose of the study is to stablish if there
  are differences between the conventional
  technique and the newer technique using FS lasers
  to obtain both the donor and recipient tissues,
  at the interphase level, using confocal
  microscopy
• Deep anterior lamellar keratoplasty (DALK)
  Anterior Lamellar Keratoplasty with FSLaser
  (FSALK).

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CONFOCAL ANALYSIS OF THE INTERPHASE

• METHODS
• Patients that underwent Anterior lamellar
  keratoplasty, were included
• A prospective study, dividing in groups according
  to technique Conventional pre-descemet technique
  compared to Femtoseconds laser(FS) assisted,
  anterior lamellar technique. An Intralase FS
  Laser Intralase Corp. Irvine,CA, was
  used.Confocal studies were done at the PreOp and
  at 1 month postOp, using a confoscan
  microscope(Fortune technology).
• The analysis of the corneal interphase, in all
  cases was done with the NAVIS software V. 3.1.2
  (NIDEK, Multi-Instrument Diagnostic System,
  Japan).

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CONFOCAL ANALYSIS OF THE INTERPHASE

• RESULTS
• 13 eyes of 13 patients were included, and divided
  in 2 groups
• Group A included 7 eyes from 7 patients
  intervened with the manual pre-descemet technique
  
• Group 2 included 6 eyes, from 5 patients,
  intervened with the FS laser.
• Group A, main preOP diagnosis were Corneal
  ectasia and Granular dystrophy. Group B main
  preOP Dx was Keratoconus.

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CON FOCAL ANALYSIS OF THE INTERPHASE

• Main findings in both groups in the Postop were
• FOLDS in the interphase, resembling a reticular
  aspect
• and
• PARTICLES, highly reflective.
• Group A showed increased reflectivity at the
  subepithelial level, particles were larger in
  number 40.2µ 34.7
• vs Group B 17.3µ11.6.
• In terms of particles size Group A, showed
  9.6µ3.7, while Group B sizes' were 5.24µ0.30.
• Both groups didn't differ strongly in terms of
  number and size of folds.

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MANUAL TECHNIQUE DEEP ANTERIOR LK
DONOR- RECIPIENT INTERPHASE Pre-Descemet 591um
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FS LASER ANTERIOR LAMELLAR INTERPHASE
PARTICLES FOLDS 384um
RETICULAR IMAGE 544um
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CONFOCAL ANALYSIS OF THE INTERPHASE

• CONCLUSIONS
• Visual quality, seems to be better in
  postPenetrating Keratoplasty(PK), compared to LK.
• This comparison, has still to be well stablished,
  since there are real advantages for LK, like less
  risk of endothelial rejection. This study shows,
  that interphases may resemble, but still show
  differences like number and size of particles.
• In terms of visual quality and quantity, we still
  dont know the real significance of particles'
  size and numbers. Folds must represent a real
  influence in vision, either due to edema or
  healing.
• We have to evaluate intensively LK to get the
  best of this technique, since the advantages can
  be a decisive point for the technique becoming
  more popular.