Safety of incomplete incision patterns in femtosecond laser-assisted penetrating keratoplasty

J Cataract Refract Surg. 2008 Dec;34(12):2099-103. doi: 10.1016/j.jcrs.2008.08.028.


Purpose: To evaluate the wound integrity of incomplete contoured corneal incisions created with a femtosecond laser at a refractive surgery center followed by subsequent patient transfer to a separate surgical facility for penetrating keratoplasty (PKP).

Setting: Private tertiary referral center, Indianapolis, Indiana, USA.

Methods: This retrospective consecutive interventional case series comprised 46 eyes that had femtosecond laser PKP. Incomplete contoured incisions were created in the recipient cornea at a refractive surgery center. Patients were then transferred to an ambulatory surgical center for PKP.

Results: The indications for PKP included keratoconus, corneal scarring, bullous keratopathy, corneal dystrophy, and failed graft. Three incision contours were used: top hat (n=26), mushroom (n=13), and zigzag (n=7). The incomplete portion of the incision was 70.0 to 300.0 microm in length. Leaving 150.0 to 300.0 microm of the lamellar ring cut incomplete did not ensure wound stability, whereas leaving 70.0 to 75.0 microm of the anterior side cut or posterior side cut incomplete provided excellent wound stability. In all eyes, the partial-thickness incisions enabled safe transport of the patient to the operating room without wound rupture, even with subsequent placement of a retrobulbar injection and a Honan balloon.

Conclusion: Incomplete femtosecond laser incision patterns that left some collagen lamellae intact maintained sufficient corneal strength to allow safe movement of the patient to a surgical facility for PKP.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cornea / surgery*
  • Corneal Diseases / surgery*
  • Female
  • Humans
  • Keratoplasty, Penetrating / adverse effects
  • Keratoplasty, Penetrating / methods*
  • Lasers, Semiconductor / adverse effects
  • Lasers, Semiconductor / therapeutic use*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surgical Wound Dehiscence / prevention & control
  • Wound Healing*