Femtosecond-Laser-Generated Zigzag-Shaped Penetrating Keratoplasty in Ethnic Japanese Patients

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Femtosecond-Laser-Generated Zigzag-Shaped
Penetrating Keratoplasty in Ethnic Japanese
Patients
Osamu Hieda, MD, PhD and Shigeru Kinoshita, MD,
PhD Department of Ophthalmology, Kyoto
Prefectural University of Medicine, Kyoto, Japan
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Financial Disclosure

• The authors have no financial interests or
  relationships to disclose.

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Patients and Methods
Eleven eyes of 11 ethnic Japanese patients (5
males, 6 females mean age 6017 years) who
underwent Zigzag PKP surgery using the IntraLase
FS60 or iFS(Abbot Medical Optics)femtosecond
laser were followed-up for a minimum of 3 months
postoperatively. All zigzag grafts were the same
size and shape, and the sizes were equal to the
zigzag cut in the host cornea. Primary diagnoses
of the patients were corneal scarring (5 eyes),
lattice dystrophy (3 eyes), keratoconus (2 eyes),
and Schnyder Corneal Dystrophy (1 eye) .
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Femtosecond Laser(FS)
IntraLase FS60

• (Nd Glass) 1053 nm
• 500-800 femtosecond pulse
• Femtosecond10-15 seconds
• Photodisruption

iFS (150KHz)
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Zigzag-Shape Incision

• ? A 300um deep and 1.00mm wide ring lamellar cut.
• The donor posterior side cut starts from the
  depth of 1200um in the artificial anterior
  chamber and the recipient posterior side cut
  starts from the thinnest or average corneal
  thickness at the peripheral 5-7mm zone of that
  cornea measured by Visante OCT(Carl Zeiss).

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Surgical Technique

• Topical and retrobulbar anesthesia for the
  recipient FS incision
• Artificial chamber for the donor FS incision
• General anesthesia for the PKP
• 8 interrupted 10-0 nylon sutures and 16-bite
  10-0 nylon running sutures were placed
• Sutures were removed on and after the
  postoperative 9th month

Moria ALTK Artificial Chamber
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Mean Best-Corrected Visual Acuity
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Mean Postoperative Astigmatism
N11
N9
Diopters ( D )
N7
N3
( Months )
One eye received laser in situ keratomileusis to
correct astigmatism at 18 months postoperative.
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Mean Endothelial Cell Density
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Case 11 Zigzag-Shape PKPPEAIOL
78-year-old Male OD Schnyder Corneal Dystrophy
Pre-Op (Decimal VA 0.2)
Post-Op 3M (0.5)
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Case 11 Excellent Corneal Topopgraphy after
PKP
Post-Op 3M
CYL 0.29, SRI 0.80, SAI 0.57
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Summary

• Femtosecond-laser-generated zigzag-shaped PKP
  resulted in rapid recovery of BCVA, and VA was
  even more improved at 12 months postoperative.
• Astigmatism decreased after LASIK surgery
  performed at 18 months postoperative.
• There was no difference in endothelial cell
  density compared to that of conventional PKP.