Skip to main content
SpringerLink
Log in
Book cover

Complications in Corneal Laser Surgery pp 199–225Cite as

Complications and Management in Laser Transplant Surgery

  • Chapter
  • First Online:

  • 459 Accesses

Abstract

Laser application without direct visual control of the operation area. Stop of power supply will stop procedure. Hyposphagma due to suction. Centration is difficult – especially in advanced keratoconus. Scars will impair incision, manual completion even with spatula or even scissors necessary. Difficult trephination and false lamellar cut depth in edematous corneas. Laser-Eye-Tracking system not feasible because of very high repetition rate and comparatively tiny focus. Not eye safe, because visible or near-IR laser must produce plasma via non-linear processes, otherwise potential deposition of laser energy on the retina. Deformation of the cornea during suction and applanation (recipient) resulting in not round (e.g., oval or pear shaped) and incongruent host incisions – FSL trephination not feasible for pathological curvatures of the cornea. Even after maximal suture adjustments, Placido disk application at the end of surgery will sometimes give you still elliptical or even irregular projections on the graft after FSL trephination in keratoconus – due to geometric mismatch. High and irregular astigmatism after suture removal – especially in advanced keratoconus. Problem of achieving the correct plane of the side cut in tophat or mushroom configurations, e.g., if an edematous donor has to prepared for a thinned keratoconus cornea. Often femtosecond laser is not placed in the sterile Operating Room. Therefore, either tissue bridges have to be intentionally left in place or even temporary interrupted sutures were placed after laser action to avoid expulsive hemorrhage during transportation from the laser suite to the operating room.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   99.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Bibliography

  1. Janunts E, Langenbucher A, Seitz B. In vitro corneal tomography of donor corneas using anterior segment OCT. Cornea. 2016;35(5):647–53.

    Article  PubMed  Google Scholar 

  2. Ninios K, Matoula P, Szentmàry N, et al. Results of excimer laser penetrating keratoplasty in aphakic eyes. Graefes Arch Clin Exp Ophthalmol. 2013;251:1185–9.

    Article  CAS  PubMed  Google Scholar 

  3. Behrens A, Seitz B, Küchle M, et al. “Orientation teeth” in nonmechanical laser corneal trephination: 2.94-microm Er:YAG laser vs. 193-nm ArF excimer laser. Br J Ophthalmol. 1999;83:1008–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Urrets-Zavalia A. Fixed dilated pupil, iris atrophy and secondary glaucoma. A distinct clinical entity following penetrating keratoplasty for keratoconus. Am J Ophthalmol. 1963;56:257–65.

    Article  PubMed  Google Scholar 

  5. Belmont SC, Troutman RC, Buzard KA. Control of astigmatism aided by intraoperative keratometry. Cornea. 1993;12:397–400.

    Article  CAS  PubMed  Google Scholar 

  6. Naumann GOH. Part II: corneal transplantation in anterior segment diseases. The Bowman Lecture (Number 56) 1994. Eye. 1995;9:395–421.

    Article  PubMed  Google Scholar 

  7. Seitz B, Langenbucher A, Naumann GOH. Trephination in penetrating keratoplasty. In: Reinhard T, Larkin F, editors. Essentials in ophthalmology – corneal and external eye disease. Berlin: Springer; 2006. p. 123–52.

    Chapter  Google Scholar 

  8. Seitz B, Hager T, Szentmáry N, Langenbucher A, Naumann GOH. [Keratoplasty in children – still a dilemma]. Klin Monatsbl Augenheilkd. 2013;230:587–94.

    Article  CAS  PubMed  Google Scholar 

  9. Cohen KL, Holman RE, Tripoli NK, Kupper LL. Effect of trephine tilt on corneal button dimensions. Am J Ophthalmol. 1986;101:722–5.

    Article  CAS  PubMed  Google Scholar 

  10. Javadi MA, Mohammadi MJ, Mirdehghan SA, Sajjadi SH. A comparison between donor-recipient corneal size and its effect on the ultimate refractive error induced in keratoconus. Cornea. 1993;12:401–5.

    Article  CAS  PubMed  Google Scholar 

  11. Perl T, Charlton KH, Binder PS. Disparate diameter grafting. Astigmatism, intraocular pressure and visual acuity. Ophthalmology. 1981;88:774–80.

    Article  CAS  PubMed  Google Scholar 

  12. Langenbucher A, Seitz B, Kus MM, Naumann GOH. [Transplant vertical tilt after perforating keratoplasty – comparison between non-mechanical trephination with excimer laser and motor trephination]. Klin Monatsbl Augenheilkd. 1998;212:129140.

    Google Scholar 

  13. Cohen KL, Tripoli NK, Pellom AC, et al. Effect of tissue fit on corneal shape after transplantation. Invest Ophthalmol Vis Sci. 1984;25:1226–31.

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  15. Mader TH, Yuan R, Lynn MJ, et al. Change in keratometric astigmatism after suture removal more than one year after penetrating keratoplasty. Ophthalmology. 1993;100:119–27.

    Article  CAS  PubMed  Google Scholar 

  16. Musch DC, Meyer RF, Sugar A. The effect of removing running sutures on astigmatism after penetrating keratoplasty. Arch Ophthalmol. 1988;106:488–92.

    Article  CAS  PubMed  Google Scholar 

  17. Seitz B, El-Husseiny M, Langenbucher A, Szentmáry N. [Prophylaxis and management of complications in penetrating keratoplasty]. Ophthalmologe. 2013;110:605–13.

    Article  CAS  PubMed  Google Scholar 

  18. Hoppenreijs VPT, Van Rij G, Beekhuis WH, Rijneveld WJ, Rinkel-Van Driel E. Causes of high astigmatism after penetrating keratoplasty. Doc Ophthalmol. 1993;85:21–34.

    Article  CAS  PubMed  Google Scholar 

  19. Van Rij G, Cornell FM, Waring III GO, Wilson LA, Beekhuis H. Postoperative astigmatism after central vs eccentric penetrating keratoplasties. Am J Ophthalmol. 1985;99:317–20.

    Article  PubMed  Google Scholar 

  20. Van Rij G, Waring III GO. Configuration of corneal trephine opening using five different trephines in human donor eyes. Arch Ophthalmol. 1988;106:1228–33.

    Article  PubMed  Google Scholar 

  21. Seitz B, Langenbucher A, Küchle M, Naumann GOH. Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after suture removal. Ophthalmology. 2003;110:2162–7.

    Article  PubMed  Google Scholar 

  22. Seitz B, Langenbucher A, Naumann GOH. [The penetrating keratoplasty – a 100-year success story]. Ophthalmologe. 2005;102:11281139.

    Google Scholar 

  23. Seitz B, Langenbucher A, Naumann GOH. [Perspectives of excimer laser-assisted keratoplasty]. Ophthalmologe. 2011;108:817–24.

    Article  CAS  PubMed  Google Scholar 

  24. Seitz B, Langenbucher A, Zagrada D, Budde W, Kus MM. [Corneal dimensions in various types of corneal dystrophies and their effect on penetrating keratoplasty]. Klin Monatsbl Augenheilkd. 2000;217:152–8.

    Article  CAS  PubMed  Google Scholar 

  25. Graef S, Maier P, Boehringer D, Auw-Haedrich C, Reinhard T. Femtosecond laser-assisted repeat keratoplasty: a case series. Cornea. 2011;30:687–91.

    Article  PubMed  Google Scholar 

  26. Szentmáry N, Seitz B, Langenbucher A, Naumann GOH. Repeat keratoplasty for correction of high or irregular postkeratoplasty astigmatism in clear corneal grafts. Am J Ophthalmol. 2005;139:826–30.

    Article  PubMed  Google Scholar 

  27. Langenbucher A, Seitz B, Kus MM, Vilchis E, Naumann GOH. Graft decentration in penetrating keratoplasty – nonmechanical trephination with the excimer laser (193 nm) versus the motor trephine. Ophthalmic Surg Lasers. 1998;29:106–13.

    CAS  PubMed  Google Scholar 

  28. Seitz B, Langenbucher A, Meiller R, Kus MM. [Decentration of donor cornea in mechanical and excimer laser trephination for penetrating keratoplasty]. Klin Monatsbl Augenheilkd. 2000;217:144–51.

    Article  CAS  PubMed  Google Scholar 

  29. Langenbucher A, Kus MM, Neumann J, Seitz B. [Calculating the localization and dimension of the real pupil in keratoconus with ray tracing of corneal topography data]. Klin Monatsbl Augenheilkd. 1999;215:163–8.

    Article  CAS  PubMed  Google Scholar 

  30. Hoffmann F. [Suture technique for perforating keratoplasty]. Klin Monatsbl Augenheilkd. 1976;169:584–90.

    CAS  PubMed  Google Scholar 

  31. Jonas JB, Budde WM. Loosening of single versus double running sutures in penetrating keratoplasty for keratoconus. Graefes Arch Clin Exp Ophthalmol. 1999;237:522–3.

    Article  CAS  PubMed  Google Scholar 

  32. Naumann GOH, Seitz B, Lang GK, Langenbucher A, Kus MM. [193 excimer laser trepanation in perforating keratoplasty]. Report of 70 patients. Klin Monatsbl Augenheilkd. 1993;203:252–61.

    Article  CAS  PubMed  Google Scholar 

  33. Lang GK, Schröder E, Koch JW, et al. Excimer laser keratoplasty. Part 2: elliptical keratoplasty. Ophthalmic Surg. 1989;86:342–6.

    Google Scholar 

  34. Lang GK, Naumann GOH, Koch JW. A new elliptical excision for corneal transplantation using an excimer laser. Arch Ophthalmol. 1990;108:914–5.

    Article  CAS  PubMed  Google Scholar 

  35. Szentmáry N, Langenbucher A, Kus MM, et al. Elliptical nonmechanical corneal trephination: intraoperative complications and long-term outcome of 42 consecutive excimer laser penetrating keratoplasties. Cornea. 2007;26:414–20.

    Article  PubMed  Google Scholar 

  36. Szentmáry N, Langenbucher A, Kus MM, Naumann GOH, Seitz B. Long-term refractive results of elliptical excimer laser penetrating keratoplasty (EELPK). Curr Eye Res. 2007;32:953–9.

    Article  PubMed  Google Scholar 

  37. Küchle M, Seitz B, Langenbucher A, Naumann GOH. Nonmechanical excimer laser penetrating keratoplasty for perforated or predescemetal corneal ulcers. Ophthalmology. 1999;106:2203–9.

    Article  PubMed  Google Scholar 

  38. Amigo G. The Maklakoff applanation tonometer. Aust J Optom. 1967;50:92–7.

    Google Scholar 

  39. Seitz B, Langenbucher A, Kus MM, Küchle M, Naumann GOH. Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology. 1999;106:1156–65.

    Article  CAS  PubMed  Google Scholar 

  40. Szentmàry N, Langenbucher A, Naumann GOH, Seitz B. Intra-individual variability of penetrating keratoplasty outcome after excimer laser versus motorized corneal trephination. J Refract Surg. 2006;22:804–10.

    PubMed  Google Scholar 

  41. Küchle M, Nguyen NX, Seitz B, et al. Blood-aqueous barrier following mechanical or nonmechanical excimer laser trephination in penetrating keratoplasty. Am J Ophthalmol. 1998;125:177–81.

    Article  PubMed  Google Scholar 

  42. Behrens A, Seitz B, Langenbucher A, et al. Lens opacities after nonmechanical vs. mechanical corneal trephination for penetrating keratoplasty in keratoconus. J Cataract Refract Surg. 2000;26:1588–95.

    Article  Google Scholar 

  43. Seitz B, Langenbucher A, Nguyen NX, et al. Graft endothelium and thickness after penetrating keratoplasty comparing mechanical and excimer laser trephination – a prospective randomised study. Graefes Arch Clin Exp Ophthalmol. 2001;239:12–7.

    Article  CAS  PubMed  Google Scholar 

  44. Seitz B, Langenbucher A, Diamantis A, et al. [Immunological graft reactions after penetrating keratoplasty – a prospective randomized trial comparing corneal excimer laser and motor trephination]. Klin Monatsbl Augenheilkd. 2001;218:710–9.

    Article  CAS  PubMed  Google Scholar 

  45. Seitz B, Langenbucher A, Nguyen NX, et al. Long-term follow-up of intraocular pressure after penetrating keratoplasty for keratoconus and Fuchs’ dystrophy – comparison of mechanical and laser trephination. Cornea. 2002;21:368–73.

    Article  PubMed  Google Scholar 

  46. Seitz B, Rozsival P, Feuermannova A, Langenbucher A, Naumann GOH. Penetrating keratoplasty for iatrogenic keratoconus after repeat myopic laser in situ keratomileusis: histologic findings and literature review. J Cataract Refract Surg. 2003;29:2217–24.

    Article  PubMed  Google Scholar 

  47. Seitz B, Langenbucher A, Nguyen NX, Kus MM, Küchle M, Naumann GOH. [Results of the first 1000 consecutive elective nonmechanical keratoplasties with the excimer laser – a prospective study over more than 12 years]. Ophthalmologe. 2004;101:478–88.

    Article  CAS  PubMed  Google Scholar 

  48. Langenbucher A, Seitz B, Kus MM, Naumann GOH. Thermal effects in excimer laser trephination of the cornea. Graefe’s Arch Clin Exp Ophthalmol. 1996;234:S142–8.

    Article  Google Scholar 

  49. Langenbucher A, Küchle M, Seitz B, Kus MM, Behrens A, Weimel E, Naumann GOH. Thermal load of laser aperture masks in nonmechanical trephination for penetrating keratoplasty with the Er:YAG laser: comparison between stainless steel and ceramic masks. Graefe’s Arch Clin Exp Ophthalmol. 2000;238:339–45.

    Article  CAS  Google Scholar 

  50. Seitz B, Cursiefen C, El-Husseiny M, Viestenz A, Langenbucher A, Szentmáry N. [DALK and penetrating laser keratoplasty for advanced keratoconus]. Ophthalmologe. 2013;110:839–48.

    Article  CAS  PubMed  Google Scholar 

  51. Shehadeh-Mashor R, Chan CC, Bahar I, Lichtinger A, Yeung SN, Rootman DS. Comparison between femtosecond laser mushroom configuration and manual trephine straight-edge configuration deep anterior lamellar keratoplasty. Br J Ophthalmol. 2014;98(1):35–9.

    Article  PubMed  Google Scholar 

  52. Anwar M, Teichmann KD. Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg. 2002;28:398–403.

    Article  PubMed  Google Scholar 

  53. Seitz B, Brünner H, Viestenz A, Hofmann-Rummelt C, Schlötzer-Schrehardt U, Naumann GOH, Langenbucher A. Inverse mushroom-shaped nonmechanical penetrating keratoplasty using a femtosecond laser. Am J Ophthalmol. 2005;139:941–4.

    Article  PubMed  Google Scholar 

  54. Bahar I, Kaiserman I, Lange AP, Levinger E, Sansanayudh W, Singal N, Slomovic AR, Rootman DS. Femtosecond laser versus manual dissection for top hat penetrating keratoplasty. Br J Ophthalmol. 2009;93:73–8.

    Article  CAS  PubMed  Google Scholar 

  55. Gaster RN, Dumitrascu O, Rabinowitz YS. Penetrating keratoplasty using femtosecond laser-enabled keratoplasty with zig-zag incisions versus a mechanical trephine in patients with keratoconus. Br J Ophthalmol. 2012;96:1195–9.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Seitz B, Langenbucher A, Naumann GOH. [Astigmatism in keratoplasty]. In: Seiler T, editor. Refraktive Chirurgie. Stuttgart: Enke; 2000. p. 197–252.

    Google Scholar 

  57. Vetter JM, Holzer MP, Teping C, et al. Intraocular pressure during corneal flap preparation: comparison among four femtosecond lasers in porcin eyes. J Refract Surg. 2011;27:427–33.

    Article  PubMed  Google Scholar 

  58. Seitz B, Szentmáry N, Langenbucher A, Hager T, Viestenz A, Janunts E, El-Husseiny M. [Penetrating keratoplasty PKP in advanced keratoconus – from hand/motor trephine up to the excimer laser and back to the femtosecond laser]. Klin Monatsbl Augenheilknd. 2016;233(6):727–36.

    Article  CAS  Google Scholar 

  59. El-Husseiny M, Seitz B, Langenbucher A, et al. Excimer vs. femtosecond laser assisted penetrating keratoplasty in keratoconus and Fuchs dystrophy: intraoperative pitfalls. J Ophthalmol. 2015;2015:645830.

    PubMed  PubMed Central  Google Scholar 

  60. Farid M, Steiner RF, Gaster RN, Chamberlain W, Lin A. Comparison of penetrating keratoplasty performed with the femtosecond laser zig-zag incision versus conventional blade trephination. Ophthalmology. 2009;116:1638–43.

    Article  PubMed  Google Scholar 

  61. Kamiya K, Kobashi H, Shimizu K, Igarashi A. Clinical outcomes of penetrating keratoplasty performed with the VisuMax femtosecond laser system and comparison with conventional penetrating keratoplasty. PLoS One. 2014;9(8):e105464.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Levinger E, Trivizki O, Levinger S, Kremer I. Outcome of “mushroom” pattern femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty in patients with keratoconus. Cornea. 2014;33:481–5.

    Article  PubMed  Google Scholar 

  63. Birnbaum F, Wiggermann A, Maier PC, Böhringer D, Reinhard T. Clinical results of 123 femtosecond laser-assisted keratoplasties. Graefes Arch Clin Exp Ophthalmol. 2013;251:95–103.

    Article  PubMed  Google Scholar 

  64. Chamberlain WD, Rush SW, Mathers WD, Cabezas M, Fraunfelder FW. Comparison of femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty. Ophthalmology. 2011;118:486–91.

    Article  PubMed  Google Scholar 

  65. Szentmáry N, Goebels S, El-Husseiny M, et al. [Immune reactions following excimer laser and femtosecond laser-assisted penetrating keratoplasty]. Klin Monatsbl Augenheilkd. 2013;230:486–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Straβe 100, Homburg/Saar, D-66424, Germany

    Berthold Seitz ML, FEBO & Moatasem El-Husseiny

  2. Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany

    Achim Langenbucher Dipl.-Ing.

Authors
  1. Berthold Seitz ML, FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moatasem El-Husseiny
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Achim Langenbucher Dipl.-Ing.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Berthold Seitz ML, FEBO .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany

    Stephan J. Linke

  2. Department of Ophthalmology, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Toam Katz

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Seitz, B., El-Husseiny, M., Langenbucher, A. (2016). Complications and Management in Laser Transplant Surgery. In: Linke, S., Katz, T. (eds) Complications in Corneal Laser Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-41496-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-41496-6_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-41494-2

  • Online ISBN: 978-3-319-41496-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation