PMID- 30798262
OWN - NLM
STAT- Publisher
LR  - 20190224
IS  - 1468-2079 (Electronic)
IS  - 0007-1161 (Linking)
DP  - 2019 Feb 23
TI  - Comparison between manual trephination versus femtosecond laser-assisted deep
      anterior lamellar keratoplasty for keratoconus.
LID - bjophthalmol-2018-313365 [pii]
LID - 10.1136/bjophthalmol-2018-313365 [doi]
AB  - BACKGROUND/AIMS: To compare the outcomes of femtosecond laser-assisted deep
      anterior lamellar keratoplasty (F-DALK) versus manual trephination DALK (M-DALK) 
      in patients with keratoconus. METHODS: In this retrospective, comparative,
      clinical study, medical charts of 860 patients with keratoconus who underwent
      F-DALK (n=391) or M-DALK (n=469) with the Melles's technique, and had at least a 
      12-month follow-up record were reviewed. The main outcome measures comprised best
      spectacle-corrected visual acuity (BSCVA), manifest refraction and keratometric
      indices. The postsurgical measurements were recorded for all patients at 12
      months (suture-in condition), and a subset of patients with complete data at 24
      months (suture-out condition; 111 F-DALK and 282 M-DALK cases). RESULTS: Both
      procedures had comparable mean (+/-SD) logMAR BSCVA at 12 months (0.18+/-0.12 for
      M-DALK and 0.17+/-0.12 for F-DALK; p=0.224) and 24 months (0.11+/-0.10 vs
      0.09+/-0.09, respectively; p=0.166) examinations. M-DALK was associated with a
      significant more residual myopia at 12 months (-3.85+/-3.27 vs -1.94+/-2.86 D;
      p<0.001), and a milder similar trend at 24 months follow-up (-2.94+/-2.72 vs
      -2.38+/-2.65 D, p=0.064). The mean keratometry (12 months: 46.15+/-1.88 vs
      44.39+/-1.72, p<0.001; 24 months: 45.33+/-2.37 vs 44.14+/-1.68, p<0.001) and
      apical keratometry values (12 months: 50.92+/-5.00 vs 47.13+/-2.38, p<0.001; 24
      months: 50.29+/-4.25 vs 48.12+/-3.81) were significantly greater for M-DALK than 
      F-DALK, while the keratometric astigmatism was similar (12 months: 2.62+/-1.58 vs
      2.53+/-1.33, p=0.364; 24 months: 3.21+/-1.83 vs 3.34+/-1.88, p=0.529).
      CONCLUSIONS: F-DALK for advanced keratoconus performs as well as M-DALK in terms 
      of BSCVA and keratometric astigmatism in both suture-in (12 months) and
      suture-out (24 months) conditions. It might have advantages over M-DALK for
      residual myopia and restoring corneal anatomy.
CI  - (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and
      permissions. Published by BMJ.
FAU - Salouti, Ramin
AU  - Salouti R
AD  - Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of
      Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
AD  - Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.
FAU - Zamani, Mohammad
AU  - Zamani M
AD  - Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.
FAU - Ghoreyshi, Maryam
AU  - Ghoreyshi M
AD  - Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.
AD  - Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz,
      Iran.
FAU - Dapena, Isabel
AU  - Dapena I
AD  - The Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The
      Netherlands.
FAU - Melles, Gerrit R J
AU  - Melles GRJ
AD  - The Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The
      Netherlands.
FAU - Nowroozzadeh, Mohammad Hossein
AU  - Nowroozzadeh MH
AD  - Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of
      Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
      nowroozzadeh@hotmail.com.
LA  - eng
PT  - Journal Article
DEP - 20190223
PL  - England
TA  - Br J Ophthalmol
JT  - The British journal of ophthalmology
JID - 0421041
OTO - NOTNLM
OT  - Manual-trephination
OT  - deep anterior lamellar keratoplasty
OT  - femtosecond
OT  - keratoconus
OT  - laser-assisted
COIS- Competing interests: None declared.
EDAT- 2019/02/25 06:00
MHDA- 2019/02/25 06:00
CRDT- 2019/02/25 06:00
PHST- 2018/10/10 00:00 [received]
PHST- 2018/12/15 00:00 [revised]
PHST- 2019/02/03 00:00 [accepted]
PHST- 2019/02/25 06:00 [entrez]
PHST- 2019/02/25 06:00 [pubmed]
PHST- 2019/02/25 06:00 [medline]
AID - bjophthalmol-2018-313365 [pii]
AID - 10.1136/bjophthalmol-2018-313365 [doi]
PST - aheadofprint
SO  - Br J Ophthalmol. 2019 Feb 23. pii: bjophthalmol-2018-313365. doi:
      10.1136/bjophthalmol-2018-313365.