Keratoconus treatment using femtosecond-assisted intrastromal corneal graft (FAISCG) surgery: a case series

International Medical Case Reports Journal Keratoconus treatment using femtosecond- assisted intrastromal corneal graft (FAISCG) surgery: a case series Khosrow Jadidi 1 Seyed Aliasghar Mosavi 0 0 Vision Health Research Center , Tehran , Iran 1 Department of Ophthalmology, Baqiyatallah University of Medical Sciences , Tehran , Iran We describe an intrastromal corneal graft technique that uses femtosecond laser to create a desirable corneal lenticule with precise diameter, depth, and shape as well as an intrastromal pocket in keratoconus patients. The technique seems to be a feasible and safe treatment option to treat keratoconic eyes with reference to the irregularity and instability of cornea. The technique can be performed easily and appears safe and effective. At 7 days postoperatively, all eyes were white and quiet, and the grafts were clear. No graft folds or interface complications were observed at the 12-month follow-up using Visante optical coherence tomography. - Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: http://youtu.be/FT7Dm_FOejQ Case reports Surgical technique The surgical procedures were performed at Basir Hospital, Tehran, Iran, and approved by the ethics committee. Four consecutive patients (men) were enrolled for the series. Written informed consent was obtained in all cases. The surgical femtosecond assisted dedoa ropeF l n w o d l a n r u o J s tr o p e R e s a C l a c i d e M l a n o it a n tr e n I intrastromal corneal graft (FAISCG) technique shown in the Video S1 is characterized by three-step procedure as follows: Step 1: Creation of a corneal lenticule in donor eye Preoperatively, epitheliums of donor eyes from the whole 8 globe were removed with a blade number 15. Subsequently, -012 a desirable corneal lenticule with precise diameter, depth, l-Ju and shape was created using Ziemer LDV femtosecond laser 21n (Ziemer AG, Port, Switzerland). To create the donor grafts, o12 corneoscleral donor tissue was removed from storage solution .982 (Optisol-GS; Bausch and Lomb Surgical, Irvine, CA, USA) ..32 and mounted on an artificial anterior chamber (LDV; Ziemer 213 Ophthalmic Systems AG). The femtosecond laser keratoplasty /yb software was programmed as follows: a donor lenticule thick.com ness of 140–250 mm, applanation 7–9 mm, vacuum value 700 rsse mbar, total cut in donor tissue 45 seconds, and an applanation vpe time ranging from 10 to 20 seconds in the patients and donors. do For donors and patients, we used 4.0 mm/s velocity of the ./www l.yno stroma and 30 mm/s velocity of the border. /:sp sue The proper depth of the cornea was defined by subtracttthm laon ing the normal corneal depth measure from the thinnest fro rs part of the recipient cornea. The shape of the lenticule was determined on the basis of keratoconus types; in central keratoconus, circular shape was chosen; in inferior keratoconus, crescent shape was chosen; and in asymmetric bow-tie keratoconus, mesopic pupil size and round shape were selected (Video S1) (Figure S1). In addition, the accurate diameter measurement was based on lenticule size. Step 2: Creation of a corneal pocket in recipient eye The intracorneal pocket entry in recipient eye was created on the steepest corneal topographic axis using femtosecond surgical laser. The pocket depth was set at 250 micron of the corneal thickness at the incision site. Then, the intracorneal pockets were gently separated from the underlying stroma using a Sinskey hook and a spatula. Step 3: Graft implantation After creation of the intrastromal pocket via the small incision while the pocket was easily opened using a dissecting spatula, an intrastromal corneal graft was implanted immediately into the corneal pocket. The graft implantation into the pocket is easily achievable. The implantation procedure and adjustment of the graft in the pocket can be performed by a Sinskey hook dedoa ropeF l n w o d l a n r u o J s tr o p e R e s a C l a c i d e M l a n o it a n tr e n I or forceps. The incision site is self-sealing and does not require suturing. The procedure takes approximately 30 minutes. Subsequently, a silicone-hydrogel bandage contact lens (Bausch and Lomb, Alcon Laboratories, Inc., Fort Worth, TX, USA) was placed on the cornea. Postoperatively, patients were given betamethasone drops (Sina Darou, Tehran, Iran) four times a day, chloramphenicol drops (Sina Darou) six times a day, and nonpreserved artificial tears (Artelac Advanced) (Baush and Lomb, Rochester, NY USA) six times daily. Chloramphenicol drops were discontinued 7 days postoperatively and betamethasone drops tapered off in 4 weeks. Bandage contact lenses were removed 1 day postoperation. Patients were scheduled for postoperative clinical examination on the 1st day, 1st week, and afterward in the 1st, 3rd, and 6th month, and yearly. Clinical data The characteristics of patients included in this case series are summarized in (...truncated)