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Perspektiven der Femtosekundenlaser-assistierten Keratoplastik

Perspectives of femtosecond laser-assisted keratoplasty

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Zusammenfassung

Durch die Einführung des Femtosekundenlasers eröffneten sich sowohl bei der perforierenden Keratoplastik als auch bei den lamellären Keratoplastiken völlig neue technische Möglichkeiten. Bei der perforierenden Keratoplastik ist es möglich, Stufenprofile wie das „Top-hat-“ oder das „Mushroom-Profil“ zu lasern. Hierdurch kann man einen stabileren intraoperativen Wundverschluss erreichen und aufgrund der größeren Wundfläche frühzeitig eine komplette Fadenentfernung durchführen. Bei den lamellären Verfahren bietet die Femtosekundenlaser-Technik die Möglichkeit, in beliebiger Tiefe der Hornhaut zu schneiden, um z. B. bei der DSAEK eine möglichst dünne Spenderlamelle zu erzielen. In diesem Beitrag wird ein Überblick über den aktuellen Stand der operativen Verfahren vermittelt, und die Perspektiven der Femtosekundenlaser-assistierten Keratoplastik werden aufgezeigt.

Abstract

The femtosecond laser technique allows completely new trephination procedures in penetrating and lamellar keratoplasty. With femtosecond laser-assisted penetrating keratoplasty it is possible to perform profiled trephination, such as top hat and mushroom profiles. Thus, it is easier to get a watertight wound closure intraoperatively and due to the larger wound surface wound healing is faster and allows early complete suture removal. In lamellar keratoplasty the femtosecond laser enables the surgeon to cut to any depth in the corneas resulting in thin corneal donor buttons, e.g. for DSAEK. In this manuscript an overview is given of the state of the art and of the perspectives of femtosecond laser keratoplasty.

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Literatur

  1. Bahar I, Kaiserman I, Lange AP et al (2009) Femtosecond laser versus manual dissection for top hat penetrating keratoplasty. Br J Ophthalmol 93:73–78

    Article  PubMed  CAS  Google Scholar 

  2. Bahar I, Kaiserman I, McAllum P, Rootman D (2008) Femtosecond laser-assisted penetrating keratoplasty: stability evaluation of different wound configurations. Cornea 27:209–211

    Article  PubMed  Google Scholar 

  3. Belmont SC, Zimm JL, Storch RL et al (1993) Astigmatism after penetrating keratoplasty using the Krumeich guided trephine system. Refract Corneal Surg 9:250–254

    PubMed  CAS  Google Scholar 

  4. Birnbaum F, Maier P, Reinhard T (2010) Femtosecond laser-assisted penetrating keratoplasty. Ophthalmologe 107:186–188

    Article  PubMed  CAS  Google Scholar 

  5. Birnbaum F, Reinhard T, Ulbricht T et al (2004) Functional results after autologous rotational keratoplasty. A retrospective study. Ophthalmologe 101:54–58

    Article  PubMed  CAS  Google Scholar 

  6. Birnbaum F, Schwartzkopff J, Böhringer D, Reinhard T (2008) Penetrating keratoplasty with intrastromal corneal ring. A prospective randomized study. Ophthalmologe 105:452–456

    Article  PubMed  CAS  Google Scholar 

  7. Birnbaum F, Schwartzkopff J, Böhringer D, Reinhard T (2011) The intrastromal corneal ring in penetrating keratoplasty-long-term results of a prospective randomized study. Cornea 30(7):780–783

    Article  PubMed  Google Scholar 

  8. Böhringer D, Schindler A, Reinhard T (2006) Satisfaction with penetrating keratoplasty. Results of a questionnaire census. Ophthalmologe 103:677–681

    Article  PubMed  Google Scholar 

  9. Buzzonetti L, Laborante A, Petrocelli G (2010) Standardized big-bubble technique in deep anterior lamellar keratoplasty assisted by the femtosecond laser. J Cataract Refract Surg 36:1631–1636

    Article  PubMed  Google Scholar 

  10. Buzzonetti L, Laborante A, Petrocelli G (2011) Refractive outcome of keratoconus treated by combined femtosecond laser and big-bubble deep anterior lamellar keratoplasty. J Refract Surg 27:189–194

    PubMed  Google Scholar 

  11. Chamberlain W, Cabezas M (2011) Femtosecond-assisted deep anterior lamellar keratoplasty using big-bubble technique in a cornea with 16 radial keratotomy incisions. Cornea 30:233–236

    Article  PubMed  Google Scholar 

  12. Chamberlain WD, Rush SW, Mathers WD et al (2011) Comparison of femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty. Ophthalmology 118:486–491

    Article  PubMed  Google Scholar 

  13. Chan CC, Ritenour RJ, Kumar NL et al (2010) Femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty. Cornea 29:290–295

    Article  PubMed  Google Scholar 

  14. Cheng YY, Hendrikse F, Pels E et al (2008) Preliminary results of femtosecond laser-assisted descemet stripping endothelial keratoplasty. Arch Ophthalmol 126:1351–1356

    Article  PubMed  Google Scholar 

  15. Cheng YY, Pels E, Nuijts RM (2007) Femtosecond-laser-assisted Descemet’s stripping endothelial keratoplasty. J Cataract Refract Surg 33:152–155

    Article  PubMed  Google Scholar 

  16. Cheng YY, Schouten JS, Tahzib NG et al (2009) Efficacy and safety of femtosecond laser-assisted corneal endothelial keratoplasty: a randomized multicenter clinical trial. Transplantation 88:1294–1302

    Article  PubMed  Google Scholar 

  17. Dursun D, Forster RK, Feuer WJ (2002) Suturing technique for control of postkeratoplasty astigmatism and myopia. Trans Am Ophthalmol Soc 100:51–57

    PubMed  Google Scholar 

  18. Ehrich D, Duncker GI (2004) The use of intracorneal rings in penetrating keratoplasty. Klin Monatsbl Augenheilkd 221:92–95

    Article  PubMed  CAS  Google Scholar 

  19. Ertan A, Kamburoglu G (2008) Intacs implantation using a femtosecond laser for management of keratoconus: comparison of 306 cases in different stages. J Cataract Refract Surg 34:1521–1526

    Article  PubMed  Google Scholar 

  20. Farid M, Kim M, Steinert RF (2007) Results of penetrating keratoplasty performed with a femtosecond laser zigzag incision initial report. Ophthalmology 114:2208–2212

    Article  PubMed  Google Scholar 

  21. Farid M, Steinert RF, Gaster RN et al (2009) Comparison of penetrating keratoplasty performed with a femtosecond laser zig-zag incision versus conventional blade trephination. Ophthalmology 116:1638–1643

    Article  PubMed  Google Scholar 

  22. Filatov V, Alexandrakis G, Talamo JH, Steinert RF (1996) Comparison of suture-in and suture-out postkeratoplasty astigmatism with single running suture or combined running and interrupted sutures. Am J Ophthalmol 122:696–700

    PubMed  CAS  Google Scholar 

  23. Hoffart L, Proust H, Matonti F et al (2008) Short-term results of penetrating keratoplasty performed with the Femtec femtosecond laser. Am J Ophthalmol 146:50–55

    Article  PubMed  Google Scholar 

  24. Jonas JB (2009) Femtosecond laser-assisted penetrating re-keratoplasty. Acta Ophthalmol 87:353–354

    PubMed  Google Scholar 

  25. Kook D, Derhartunian V, Bug R, Kohnen T (2009) Top-hat shaped corneal trephination for penetrating keratoplasty using the femtosecond laser: a histomorphological study. Cornea 28:795–800

    Article  PubMed  Google Scholar 

  26. Krumeich J, Binder PS, Knulle A (1988) The theoretical effect of trephine tilt on postkeratoplasty astigmatism. CLAO J 14:213–219

    PubMed  CAS  Google Scholar 

  27. Kullman G, Pineda R 2nd (2010) Alternative applications of the femtosecond laser in ophthalmology. Semin Ophthalmol 25:256–264

    Article  PubMed  Google Scholar 

  28. Maier P, Reinhard T (2009) Keratoplasty: laminate or penetrate? Part 1: Penetrating keratoplasty. Ophthalmologe 106:563–569; quiz 570

    Article  PubMed  CAS  Google Scholar 

  29. Maier PC, Birnbaum F, Reinhard T (2010) Therapeutic applications of the femtosecond laser in corneal surgery. Klin Monatsbl Augenheilkd 227:453–459

    Article  PubMed  CAS  Google Scholar 

  30. Mehta JS, Shilbayeh R, Por YM et al (2008) Femtosecond laser creation of donor cornea buttons for Descemet-stripping endothelial keratoplasty. J Cataract Refract Surg 34:1970–1975

    Article  PubMed  Google Scholar 

  31. Monterosso C, Fasolo A, Caretti L et al (2011) Sixty-kilohertz femtosecond laser-assisted endothelial keratoplasty: clinical results and stromal bed quality evaluation. Cornea 30:189–193

    Article  PubMed  Google Scholar 

  32. Mootha VV, Heck E, Verity SM et al (2011) Comparative study of descemet stripping automated endothelial keratoplasty donor preparation by Moria CBm microkeratome, horizon microkeratome, and Intralase FS 60. Cornea 30:320–324

    PubMed  Google Scholar 

  33. Murta JN, Amaro L, Tavares C, Mira JB (1994) Astigmatism after penetrating keratoplasty. Role of the suture technique. Doc Ophthalmol 87:331–336

    Article  PubMed  CAS  Google Scholar 

  34. Musch DC, Meyer RF, Sugar A, Soong HK (1989) Corneal astigmatism after penetrating keratoplasty. The role of suture technique. Ophthalmology 96:698–703

    PubMed  CAS  Google Scholar 

  35. Naumann GO (1995) The Bowman lecture. Eye 9(Pt 4):395–421

    Article  PubMed  Google Scholar 

  36. Nubile M, Carpineto P, Lanzini M et al (2009) Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty. Ophthalmology 116:1083–1092

    Article  PubMed  Google Scholar 

  37. Price FW Jr, Price MO (2008) Femtosecond laser shaped penetrating keratoplasty: one-year results utilizing a top-hat configuration. Am J Ophthalmol 145:210–214

    Article  PubMed  Google Scholar 

  38. Price FW Jr, Price MO, Grandin JC, Kwon R (2009) Deep anterior lamellar keratoplasty with femtosecond-laser zigzag incisions. J Cataract Refract Surg 35:804–808

    Article  PubMed  Google Scholar 

  39. Ratkay-Traub I, Juhasz T, Horvath C et al (2001) Ultra-short pulse (femtosecond) laser surgery: initial use in LASIK flap creation. Ophthalmol Clin North Am 14:347–355, viii–ix

    PubMed  CAS  Google Scholar 

  40. Reinhard T, Sundmacher R, Greber H (1992) Surgical correction of astigmatism after perforating keratoplasty. Ophthalmologe 89:495–497

    PubMed  CAS  Google Scholar 

  41. Ruhswurm I, Scholz U, Pfleger T et al (1999) Three-year clinical outcome after penetrating keratoplasty for keratoconus with the guided trephine system. Am J Ophthalmol 127:666–673

    Article  PubMed  CAS  Google Scholar 

  42. Seitz B, Langenbucher A, Kus MM et al (1999) Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology 106:1156–1164

    Article  PubMed  CAS  Google Scholar 

  43. Seitz B, Langenbucher A, Naumann GO (2005) The penetrating keratoplasty. A 100-year success story. Ophthalmologe 102:1128–1129

    Article  PubMed  CAS  Google Scholar 

  44. Shousha MA, Yoo SH, Kymionis GD et al (2011) Long-term results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty. Ophthalmology 118:315–323

    Article  PubMed  Google Scholar 

  45. Steinert RF, Ignacio TS, Sarayba MA (2007) Top hat-shaped penetrating keratoplasty using the femtosecond laser. Am J Ophthalmol 143:689–691

    Article  PubMed  Google Scholar 

  46. Rij G van, Saelens IE, Bartels MC (2010) Femtosecond laser versus manual dissection for top hat penetrating keratoplasty. Br J Ophthalmol 94:139–140

    PubMed  Google Scholar 

  47. Por YM, Cheng JY, Parthasarathy A et al (2008) Outcomes of femtosecond laser-assisted penetrating keratoplasty. Am J Ophthalmol 145(5):772–774

    Article  PubMed  Google Scholar 

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  1. Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland

    F. Birnbaum, P. Maier & T. Reinhard

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  1. F. Birnbaum
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  2. P. Maier
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  3. T. Reinhard
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Correspondence to F. Birnbaum.

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Birnbaum, F., Maier, P. & Reinhard, T. Perspektiven der Femtosekundenlaser-assistierten Keratoplastik. Ophthalmologe 108, 807–816 (2011). https://doi.org/10.1007/s00347-011-2334-9

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