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Femtosecond Laser Assisted Keratoplasty
Jorge L Alio, Alfredo Vega, Felipe Soria
CHAPTER 1:
Femtosecond Laser Corneal Tissue Interaction
INTRODUCTION
INTERACTION PROCESSES IN MATERIALS WITH HIGH INTENSITIES
FEMTOSECOND SURGERY
LIGHT-TISSUE INTERACTION
FUTURE DIRECTIONS
APPENDIX
ACKNOWLEDGMENTS
CHAPTER 2:
Femtosecond Laser Technology for Ophthalmic Surgeons and Clinicians: Understanding a New Emerging Technology
INTRODUCTION
BASIC CONCEPTS: CREATING LIGHT AMPLIFICATION STIMULATED EMISSION RADIATION
Energy Levels
Normal Population, Pumping and Inversion Population: Stimulation
What Goes Up, Must Come Down and Out (Emission Radiation)
WAVES IN TIME AND SPACE: UNDERSTANDING LASERS IN OPHTHALMOLOGY
Electromagnetic Spectrum
Wavelength
Frequency
Relation between Energy and Wavelength
Relation between Energy and Time
Extreme Precision: Numerical Aperture
Speed Repetition Rates: Total Time Procedure and Total Energy Delivered to the Cornea
Corneal Femtosecond Laser vs Cataract Femtosecond Laser
LASER-MATTER INTERACTION
Femtosecond Laser Beam Output
Pulse Anatomy
Settings of Femtosecond Laser9
Stepping on the Foot Pedal
A Matter of Exciting Electrons: Creating Optical Breakdown (Photoionization) and Plasma Formation12,13
A Matter of Bubbles: Photodisruption in Order to Achieve Tissue Ablation
CHAPTER 3:
Femtosecond Laser Corneal Graft Applications with IntraLase Technology
INTRALASE FEMTOSECOND LASER ACTION ON CORNEAL TISSUE
INTRALASE ENABLED KERATOPLASTY
IntraLase Enabled Keratoplasty Incision Design Software
Posterior Side Cut
Lamellar Cut
Anterior Side Cut
Alignment Incisions
IntraLase Enabled Keratoplasty Incision Profiles
Top-Hat Based Edge Profile
Mushroom Based Edge Profile
Zigzag Based Edge Profile
Basics on Femtosecond Graft Architecture
Incision Intersection
Lamellar Cut Depth
Oversizing
Deepest Posterior Point
SURGICAL PROTOCOL
Donor
Artificial Anterior Chamber Pressure Management
Recipient
Graft Manipulation
Suturing
AD-HOC CUSTOMIZATION
Deep Stromal Anterior Keratoplasty
Penetrating Keratoplasty
Deep Stromal Endothelial Keratoplasty
Astigmatic Keratotomy Postcorneal Graft Surgery
DISCLOSURE
CHAPTER 4:
Therapeutic Procedures Using the VICTUS™ Femtosecond Laser Platform
INTRODUCTION
KEY FEATURES OF THE VICTUS FEMTOSECOND LASER PLATFORM
INTERFACE
THERAPEUTIC PROCEDURES
PENETRATING KERATOPLASTY
CUT DESIGN
VARIABLE DIAMETER
SHAPE DESIGN
CAUSE FOR KERATOPLASTY
SURGICAL TECHNIQUE
VISUAL RESULTS
COMPARISON OF THE RESULTS WITH PUBLISHED DATA
DEEP ANTERIOR LAMELLAR GRAFTS
ENDOTHELIAL KERATOPLASTY/ POSTERIOR LAMELLAR GRAFTS
ADDITIONAL PROCEDURES PERFORMED WITH THE TECHNOLAS FEMTOSECOND LASER
Custom Shape Astigmatic Keratotomies (AK)
Custom Shape Implantable Corneal Ring Segments (ICRS)
COSTS
CHAPTER 5:
Femtosecond Laser Corneal Applications: Wavelight FS200
TECHNOLOGY DESCRIPTION
CORNEAL THERAPEUTIC APPLICATIONS
CHAPTER 6:
Femtosecond Laser-Assisted Superficial Lamellar Keratectomy for the Treatment of Superficial Corneal Leukomas
INTRODUCTION
PREOPERATIVE CONSIDERATIONS
Indications
Preoperative Studies
General Considerations
SURGICAL TECHNIQUE
OUTCOMES16
Visual Acuity
Refraction
Corneal Haze and Opacity
Corneal Topography and Aberrometry
COMPLICATIONS
CONCLUSION
CHAPTER 7:
Artificial Anterior Chamber Systems Used for Femtosecond Laser Corneal Graft Surgery
INTRODUCTION
DESCRIPTION OF ARTIFICIAL ANTERIOR CHAMBERS MODELS
Non-disposable Artificial Anterior Chambers
Disposable Artificial Anterior Chambers
Coronet Disposable Artificial Anterior Chambers (Figs 7.8 and 7.9)
Moria Disposable Artificial Anterior Chambers (Figs 7.10 and 7.11)
Barron Disposable Artificial Anterior Chambers (Fig. 7.12)
HOW TO USE AN ARTIFICIAL ANTERIOR CHAMBER IN FEMSTOSECOND LASER-ASSISTED KERATOPLASTY
COMPLICATIONS
CLINICAL PEARLS IN USING AN ARTIFICIAL ANTERIOR CHAMBER FOR FEMTO-KERATOPLASTY
CHAPTER 8:
Femtosecond Laser-Assisted Penetrating Keratoplasty with IntraLase Technology(Use of the Different Technologies, Surgical Practical Pearls, Outcomes)
INTRODUCTION
Penetrating Keratoplasty versus Lamellar Procedures
Incision Configuration
Incision Creation with Femtosecond Laser Enabled Keratoplasty
FEMTOSECOND LASER-ASSISTED PENETRATING KERATOPLASTY
Preoperative Considerations
Indications1,10
Preoperative Studies
General Considerations
Anesthesia
Ophthalmological Examination
SURGICAL PROCEDURE FOR CORNEAL RECEPTOR
Pattern Shape Selection (Figs 8.4A to C)
Zig-Zag Pattern
Top-Hat Pattern
Mushroom Pattern
SURGICAL PROCEDURE FOR CORNEAL DONOR IN THE MORIA ARTIFICIAL ANTERIOR CHAMBER
Setting up the Materials
Setting up the Sclerocorneal Donor in the Anterior Artificial Chamber and Proceeding with the IntraLaser Procedure
Outcomes
Cases Examples
Case 1
Case 2
CONCLUSIONS
CHAPTER 9:
Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty (Flalk) with IntraLase Technology (Use of the Different Technologies, Surgical Practical Pearls, Outcomes)
INTRODUCTION
FEMTOSECOND LASER-ASSISTED DEEP ANTERIOR LAMELLAR KERATOPLASTY
Preoperative Considerations
Indications
Preoperative Evaluation
General Considerations
Anesthesia11
OPHTHALMOLOGICAL EXAMINATION
Visual Acuity and Refraction
Corneal Topography
Corneal Pachymetry
Anterior Segment Optical Coherence Tomography
Specular Microscopy
SURGICAL PROCEDURE FOR CORNEAL RECEPTOR
Mushroom Pattern (Figs 9.2A and B)
Benefits
Disadvantages
IntraLase Settings Sample
SURGICAL PROCEDURE FOR CORNEAL DONOR WITH THE MORIA's ARTIFICIAL ANTERIOR CHAMBER (FIG. 9.11)
Setting up the Materials
Setting up the Sclerocorneal Donor in the Anterior Artificial Chamber and Proceeding with the IntraLaser Procedure
OVERVIEW OF OUTCOMES REPORTED IN FEMTOSECOND ASSISTED DALK
SUMMARY
CHAPTER 10:
Femtosecond Laser-Assisted Penetrating Keratoplasty (Flapk) with Wavelight FS-200 Technology(Use of the Different Technologies, Surgical Practical Pearls, Outcomes)
INTRODUCTION
POST-KERATOPLASTY ASTIGMATISM IS STILL AN ISSUE
REDUCING POTENTIAL COMPLICATIONS
STANDARD PROCEDURE
SUTURE TECHNIQUE REMAINS IMPORTANT
CHAPTER 11:
Femtosecond Laser-Assisted Endothelial Lamellar Keratoplasty: Optimizing Endothelial Graft Preparation: Laser Setting and Results
INTRODUCTION
CUTTING PROFILES
Single Path Profile
Double Path Profile
Double Layer Profile
Mixed Procedures
PREPARATION FROM ENDOTHELIAL SIDE
LASER SETTINGS AND OPTIMIZATION
CLINICAL RESULTS
CONCLUSION
INDEX
TOC
Index
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