2. Femtosecond Laser–Assisted Sutureless Anterior Lamellar Keratoplasty
Einollahi MD
Shahid behshti ophthalmic excellence

3. Minimizes potential intraoperative Complications
Anterior LK provides several advantages over conventional full-thickness keratoplasty
Minimizes potential intraoperative Complications
Faster visual and refractive recovery
Maintaining the recipient endothelial layer decreases the rate of graft rejection
perform multiple lamellar (anterior, stromal, posterior– endothelial) corneal transplantations from one donor’s cornea

4. Anterior lamellar kerato plasty (ALK)
Is a partial-thickness corneal transplantation used in eyes with pathology limited to the anterior layers
Superficial corneal scars after
Trauma
keratitis
epithelial/ anterior stromal dystrophies

5. Anterior stromal dystrophies

6. The major limitations with anterior LK are the technical challenges
Difficult to performing manual dissections
The resulting stromal interface irregularities between the donor and recipient interface
stromal interface haze
Induced irregular astigmatism
Loss of (BCVA)

7. Recent procedure to minimize ALK difficulties
The improvements in automated micro keratomes and artificial anterior chambers (ALTK)
Femtosecond Laser–Assisted Sutureless Anterior Lamellar Keratoplasty

8. Sutureless femtosecond Laser–Assisted Anterior Lamellar Keratoplasty(FALK)
Highly reproducible dimensions of the cuts at the graft– host junction
Accurate the shape and corneal dimensions
of the donor and recipient
safe
Efficient

9. Sutureless FALK The high precision and reproducibility of femtosecond
A smoother donor– host interface
Less induced Irregular astigmatism and Interface haze
Faster and better wound healing, without the need for sutures
Excimer laser in the PTK mode successfully treat superficial corneal opacities or refractory error in Bed

10. Reduced incidence of flap complications
The main advantages of femtosecond laser over mechanical microkeratome are
Reduced incidence of flap complications
Greater surgeon choice of flap diameter and thickness, side cut angle, hinge position, and length
A more regular corneal surface
can create flaps as thin as 90 mm

11. FALK superior than PTK

12. Sutureless FALK Surgical Technique
Performed Anterior segment ocular coherence
tomography OCT before surgery
Performed under topical anesthesia
Create the donor graft with femtosecond Laser from donor globe

13. Corneal OCT

14. Sutureless FALK Surgical Technique…
The lenticule adjusted in relation to depth of the lesions according to the anterior segment OCT findings
Depending on the donor tissue quality and edema, additional thickness was added to the donor lenticule to adjust for donor tissue swelling
A recipient corneal lenticule was created using similar femtosecond laser or 0.1 mm smaller

15. Sutureless FALK Surgical Technique
After the procedure, the patient was transferred to the surgery room, where the corneal button was removed with a blunt spatula leaving the clear stromal residual bed
The keratectomy incision was dried with methylcellulose sponges
After approximately 5 minutes (to dehydrate the cornea and improve adhesion
A bandage contact lens was fitted over the cornea

16. Post operation
Patients were then placed on a topical antibiotic and steroid for 1 week, and steroid drops were slowly tapered over several months
A bandage contact lens removed over the cornea after 2 weeks

17. Sutureless FALK Surgical Technique
Femtosecond laser energy adjustments should be considered
Patients with severe corneal scars totally obscuring visualization of anterior segment structures were excluded because of concern that the scars’ opacification could scatter laser energy

18. Complications Residual corneal scarring Residual deposits
Anisometropia
Dry eye
Graft dislocation
graft rejection
Infection
Epithelial ingrowth

19. Epithelial ingrowth

20. Suture less FALK Surgical Technique

21. Suture less FALK Surgical Technique
Pre OP
Post OP