A.V. BELODEDOVA, O.P. ANTONOVA, B.E. MALYUGIN

1. Fyodorov Eye Microsurgery Federal State Institution, 59а Beskudnikovsky Blvd, Moscow, Russian Federation, 127486

 Belodedova A.V. — postgraduate student, e-mail: ale.belodedova@gmail.com

Antonova O.P. — PhD (medicine), Junior Researcher, e-mail: antonova.mntk@gmail.com

Malyugin B.E. — D. Sc. (medicine), Professor, Deputy Director for Scientific work, tel. (499) 488-85-11, e-mail: boris.malyugin@gmail.com

 Objective ― to evaluate the safety and effectiveness of modified technique of femto-assisted deep anterior lamellar keratoplasty with intrastromal tunnels creation for «big bubble» technique in patients with keratoconus.

Material and methods. The study included 10 patients (10 eyes) with III-IV grade of keratoconus (Amsler classification). Femto LDV Z8 (Ziemer) laser was programmed to perform the lamellar cut with two intrastromal tunnels positioned at 3 and 9 o’clock at an angle of 45^o towards the cornea center. After the femtosecond laser finished working, the channels were opened with spatula and about 1.5 ml of air was injected by 27G blunt cannula to create a «big bubble».

Results. In 9 cases out of 10 (90%) the procedure was completed successfully, the «big bubble» was created. In 1 case out of 10 (10%) a perforation of Descemet’s membrane (DM) occurred, so the surgery had to be converted into PKP. In 2 cases out of 10 (20%) air injection through one channel was insufficient to achieve a «big bubble». All patients showed statistically significant improvements by all assessed criteria (NCVA, BCVA, Kmax, pachymetry, surface asymmetry index and surface regularity index) compared with preoperative results.

Conclusions. The modified technique of femto-assisted deep anterior lamellar keratoplasty with intrastromal tunnels creation for «big bubble» technique is a safe and effective procedure. Its advantages are: lower risk of DM perforation, reduced length of the whole procedure, good clinical outcomes. However, further studies with larger number of surgeries are needed to confirm these potential advantages and the superiority of that new technique compared to the classical one.

Key words: keratoconus, deep anterior lamellar keratoplasty, femtosecond laser, «big bubble» technique.

(For citation: Belodedova A.V., Antonova O.P., Malyugin B.E. Femto-assisted deep anterior lamellar keratoplasty with intrastormal tunnels for «big bubble» technique in patients with keratoconus. First clinical-functional results. Practical Medicine. 2018)

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