IntraLase Enabled Anterior Lamellar Keratoplasty
Corneal Transplant Surgery must be performed with consideration of diseased segment of the cornea. In the past there has been difficulty in properly diagnosing and measuring segments of the cornea and difficulty in properly reacting to these measurements.
Visante Anterior Segment Optical Coherence Tomography (Carl Zeiss Meditec, Dublin, CA) has revolutionized our ability to assess the Anterior Segment. It allows for precise measurements.
IntraLase Femtosecond Laser (Advanced Medical Optics, Irvine, CA) has revolutionized microscopic ophthalmic surgery with giving surgeons the capacity to plan exact incision planes. This new surgical "knife" gives a level of precision never experienced in the past.
Combining the diagnostics of the Visante OCT and the IntraLase FS Laser creates a powerful combination that has only been dreamt about in the past. The following case presentation is one to demonstrate such.
19 year old patient with history of contact lens ulcer 2 months previously developed a dense central corneal scar. The scar reduced the vision to counting finger vision in this eye. The most common surgical option considered for this patient would be a full thickness corneal transplant surgery or possibly a deep anterior lamellar keratoplasty.
On the Visante Anterior Segment OCT, The patient was fully assessed to have a dense central but anterior scar as noted on the left.
But on the High Resolution Visante OCT image it can be easily measure to be 270 microns, as seen below.
Patient underwent IntraLase Enabled Anterior Lamellar Keratoplasty by removing the anterior 270 microns and replacing it with clear donor tissue. The Visante image immediately after the IntraLase cut can be seem below.
The anterior scared cornea was then removed and replaced with a clear cornea cut to same exact size. The post operative change can be easily noted in the Visante image taken only 10 days after the IntraLase Lamellar Keratoplasty. The patients vision has improved to 20/50 from counting figure pre-operatively.
The clinical recovery was very rapid, similar to LASIK eye surgery, and the new corneal transplant was placed without any sutures. As the cornea continues to heal, we hope the vision will also continue to improve. Here is a photograph of the eye 10 days after the surgery.
This case presentation proves the power of Visante and the IntraLase that was able to bring a magical therapy to this patient. The patient is able to keep his own endothelial layer and therefore virtually eliminating the possibility of corneal transplant rejection. Patient avoided a 1 year recovery period required for full corneal transplant or even Deep Anterior Lamellar Keratoplasty. Even at 10 days post-operatively with an incompletely healed epithelium, this patient was 20/50 and back to work with greatly improved vision. The minimal central opacity that can be noted will most likely diminish in time and be of little to no significance.
3 Month Follow-Up Visit
At the 3 1/2 month post-operative visit he was noted to have a refraction of -6.00+2.00x090 in the right eye (unaffected eye) --> 20/20 and an UCVA of 20/50 in the left eye (surgical eye) and with a refraction of -1.25+1.00x104 he was correctable to 20/25. His hard contact lens BCVA refraction was also 20/25. The central haze had faded significantly.
Dr. Ash is the first surgeon to bring this magic to northern California. Dr. Ash performs the IntraLase Enabled Keratoplasty surgeries and Visante Anterior Segment OCT evaluations at Northern California Laser Center, Modesto, California.