Manual Vs FS Keratoplasty Types of trephines & punches : •

Manual Vs FS Keratoplasty
Tamer M. El-Raggal, MD, PhD, FRCSEd
Professor of Ophthalmology
Ain Shams University
ESOIRS 2014
Types of trephines & punches :
• True Manual (first1905)
• Suction (70-130 $)
• Mechanised (preset)
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•Low cost
•Easy
•Fast
•Reproducible
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FS Machines
•
Expensive (700.000 $)
•
Patient interface (140 -200 $) x 2 •
Extra room
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NOT SUITABLE IN:
Many patients are not candidates
• Tectonic (Descematocele, perforation)
• Irregular surface
• Difficult obtain and maintain suction e.g. bleb
• Previous incisional corneal surgery
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NOT SUITABLE IN:
Inability to obtain adequate laser trephination
• Oedematous grafts
• Scarred corneal periphery
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DISADVANTAGES IN PKP
•Learning curve
•Increased duration of surgery (>30 min)
•Vacuum loss during procedure —— Manual (graft already cut)
•2 rooms —— premature AC open —— infection
(remote location of laser machine)
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•
Complete wound —— Wound rupture ———Suprachoroidal hge
during patient transfer
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•Anaesthesia: Peri/retrobulbar block with partially trephined cornea •Artificial AC — more instruments —— more (expenses + infection) •Donor epithelial & endothelial injury
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•
Complexity of equipments & need for trained staff
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•
Completed with scissors
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•
Long time pressure (>5 min.) — glaucoma
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•More exact suture depth placement
•Difficult suturing —— Poor closure
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•
Less sutures —— astigmatism
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Decagonal keratoplasty
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DISADVANTAGES IN DALK
•No DM baring
•Stromal interface haze
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DISADVANTAGES IN DSAEK
•No DM stripping
•Stromal interface haze
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•Incomplete dissection (donor tissue damage)
•Endothelial damage (direct energy)
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No DMEK & No PDEK
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Conclusion
•
While FS laser
ser offers advantage of more precise incisio
incision creation for
LK & PK, disadvantages
sadvantages associated with its use limited iits widespread
use.
•
It remains to be seen whether FS laser represen
represents “future” of
incisional corneal
orneal surgery ???
•
We must be
e cautious in application of this technology, remembering
that still “a work in progress”.
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THANK YOU
ESOIRS 2014
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