Effects of Femtosecond Laser-assisted Minimally Invasive Lamellar Keratoplasty (FL-MILK) on Mild-to-moderate and Advanced Keratoconus

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2023 May 12

PMID 37171602

Authors

Na Li

Mingna Liu

Ge Tian

Tong Chen

Yue Lin

Xiaolin Qi

Weiyun Shi

Hua Gao

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the outcomes of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) for mild-to-moderate keratoconus (KC) and advanced KC.

Methods: Prospective case series study. Sixty-three eyes of 56 patients with progressive KC underwent FL-MILK were divided into group 1 [mean keratometry (Kmean) ≤ 53D] and group 2 (Kmean > 53D). Best spectacle-corrected visual acuity (BSCVA), Kmean, maximum keratometry (Kmax), anterior central corneal elevation (ACE), stiffness parameter A1 (SP-A1) and deformation amplitude (DA) were evaluated preoperatively and up to 24 months postoperatively.

Results: Mean BSCVA improved from 0.34 ± 0.13 logMAR preoperatively to 0.25 ± 0.13 logMAR at 24 months postoperatively in group 1 (F = 10.10, P < .0001), and from 0.54 ± 0.31 logMAR to 0.40 ± 0.26 logMAR (F = 9.06, P = .0002) in group 2. Group 2 showed an average Kmax reduction of 10.9 D and an average Kmean reduction of 3.9 D at 24 months postoperatively (both P < .0001), whereas no significant change was observed in group 1. Average ACE decreased from 19.2 ± 10.0 to 5.2 ± 8.4 at 24 months postoperatively in group 1 (F = 28.5, P < .0001), and from 46.2 ± 16.3 to 19.1 ± 9.0 (F = 49.6, P < .0001) in group 2; SP-A1 increased from 53.8 ± 12.7 mmHg/mm to 95.9 ± 20.2 mmHg/mm in group 1 (F = 70.0, P < .0001), and from 38.6 ± 13.4 mmHg/mm to 89.3 ± 18.2 mmHg/mm (F = 96.9, P < .0001) in group 2; DA decreased from 1.30 ± 0.14 mm to 1.17 ± 0.13 mm in group 1 (F = 14.0, P < .0001), and from 1.40 ± 0.16 mm to 1.18 ± 0.10 mm (F = 27.6, P < .0001) in group 2.

Conclusions: FL-MILK can stabilize progressive KC in mild-to-moderate cases and advanced cases at 24-month follow-up. Steeper corneas are more likely to undergo flattening after FL-MILK.

Clinical Trial: Date of registration: July 16, 2017. The title of the trail: www.

Clinicaltrials: gov Trial registration number: NCT03229239. The name of the trial registry: ClinicalTrials.gov.

Citing Articles

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References

Mas Tur V, MacGregor C, Jayaswal R, OBrart D, Maycock N . A review of keratoconus: Diagnosis, pathophysiology, and genetics. Surv Ophthalmol. 2017; 62(6):770-783. DOI: 10.1016/j.survophthal.2017.06.009. View

Ferrari G, Rama P . The keratoconus enigma: A review with emphasis on pathogenesis. Ocul Surf. 2020; 18(3):363-373. DOI: 10.1016/j.jtos.2020.03.006. View

Dou S, Wang Q, Zhang B, Wei C, Wang H, Liu T . Single-cell atlas of keratoconus corneas revealed aberrant transcriptional signatures and implicated mechanical stretch as a trigger for keratoconus pathogenesis. Cell Discov. 2022; 8(1):66. PMC: 9276680. DOI: 10.1038/s41421-022-00397-z. View

Mou Y, Qin Q, Huang X, Jin X . Risk factors and severity of keratoconus on the East Coast of China. Int Ophthalmol. 2022; 42(7):2133-2140. DOI: 10.1007/s10792-022-02212-w. View

Yang K, Gu Y, Xu L, Fan Q, Zhu M, Wang Q . Distribution of pediatric keratoconus by different age and gender groups. Front Pediatr. 2022; 10:937246. PMC: 9339668. DOI: 10.3389/fped.2022.937246. View

Kennedy R, Bourne W, Dyer J . A 48-year clinical and epidemiologic study of keratoconus. Am J Ophthalmol. 1986; 101(3):267-73. DOI: 10.1016/0002-9394(86)90817-2. View

Gao H, Huang T, Pan Z, Wu J, Xu J, Hong J . Survey report on keratoplasty in China: A 5-year review from 2014 to 2018. PLoS One. 2020; 15(10):e0239939. PMC: 7561196. DOI: 10.1371/journal.pone.0239939. View

Park C, Lee J, Gore P, Lim C, Chuck R . Keratoplasty in the United States: A 10-Year Review from 2005 through 2014. Ophthalmology. 2015; 122(12):2432-42. DOI: 10.1016/j.ophtha.2015.08.017. View

Parker J, van Dijk K, Melles G . Treatment options for advanced keratoconus: A review. Surv Ophthalmol. 2015; 60(5):459-80. DOI: 10.1016/j.survophthal.2015.02.004. View

10.

Hafezi F, Mrochen M, Iseli H, Seiler T . Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas. J Cataract Refract Surg. 2009; 35(4):621-4. DOI: 10.1016/j.jcrs.2008.10.060. View

11.

Li J, Wei S, Zhang Y, Yang D, Tian Z, Du J . Posterior corneal elevation changes and characteristic analysis 1 year after corneal collagen cross-linking for keratoconus. Int Ophthalmol. 2022; 42(5):1457-1468. DOI: 10.1007/s10792-021-02135-y. View

12.

Henein C, Nanavaty M . Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye. 2016; 40(1):3-14. DOI: 10.1016/j.clae.2016.10.001. View

13.

Song Y, Zhang J, Pan Z . Systematic Review and Meta-Analysis of Clinical Outcomes of Penetrating Keratoplasty Versus Deep Anterior Lamellar Keratoplasty for Keratoconus. Exp Clin Transplant. 2019; 18(4):417-428. DOI: 10.6002/ect.2019.0123. View

14.

Wittig-Silva C, Chan E, Islam F, Wu T, Whiting M, Snibson G . A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology. 2014; 121(4):812-21. DOI: 10.1016/j.ophtha.2013.10.028. View

15.

Kobashi H, Song Rong S . Corneal Collagen Cross-Linking for Keratoconus: Systematic Review. Biomed Res Int. 2017; 2017:8145651. PMC: 5485290. DOI: 10.1155/2017/8145651. View

16.

Li J, Ji P, Lin X . Efficacy of corneal collagen cross-linking for treatment of keratoconus: a meta-analysis of randomized controlled trials. PLoS One. 2015; 10(5):e0127079. PMC: 4436191. DOI: 10.1371/journal.pone.0127079. View

17.

Wollensak G, Spoerl E, Seiler T . Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003; 135(5):620-7. DOI: 10.1016/s0002-9394(02)02220-1. View

18.

Gao H, Liu M, Li N, Chen T, Qi X, Xie L . Femtosecond laser-assisted minimally invasive lamellar keratoplasty for the treatment of advanced keratoconus. Clin Exp Ophthalmol. 2022; 50(3):294-302. DOI: 10.1111/ceo.14047. View

19.

Ishii R, Kamiya K, Igarashi A, Shimizu K, Utsumi Y, Kumanomido T . Correlation of corneal elevation with severity of keratoconus by means of anterior and posterior topographic analysis. Cornea. 2012; 31(3):253-8. DOI: 10.1097/ICO.0B013E31823D1EE0. View

20.

Krumeich J, Daniel J, Knulle A . Live-epikeratophakia for keratoconus. J Cataract Refract Surg. 1998; 24(4):456-63. DOI: 10.1016/s0886-3350(98)80284-8. View