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Investigation of Femtosecond Laser–Enabled Keratoplasty Wound Geometry Using Optical Coherence Tomography

Heur, Martin MD, PhD; Tang, Maolong PhD; Yiu, Samuel MD, PhD; Zhang, Xinbo PhD; Huang, David MD, PhD

doi: 10.1097/ICO.0b013e3182041fd3
Clinical Science

Purpose: To measure the wound geometry after femtosecond laser-enabled keratoplasty (FLEK) using optical coherence tomography (OCT).

Design: Prospective nonrandomized clinical study and laboratory study.

Participants: Patients who were candidates for penetrating keratoplasty at an academic referral center.

Methods: Wound architecture was measured and analyzed by OCT in 8 eyes of 8 consecutive patients who underwent FLEK. Femtosecond laser lamellar cuts were performed on 3 eye bank corneas, and the wound diameters were measured by OCT.

Results: Sutures were completely removed on average at 1 month per decade of age after surgery. No cases of wound dehiscence were noted, and graft-host tissue apposition appeared excellent on OCT. The mean spectacle-corrected visual acuity 1 month after suture removal was 20/35, and mean astigmatism was 5.0 diopters by manifest refraction and 8.7 diopters by computerized topography. The measured graft diameter was smaller than the laser setting by 2.5% (P = 0.007). The cut diameters of the eye bank corneas were also slightly smaller than the laser setting.

Conclusions: FLEK offers benefits of rapid wound healing and predictable wound geometry. The measured wound geometry agreed well with laser setting other than a small systematic deviation that could be explained by the mechanics of corneal applanation during the laser cut. OCT is a useful tool to measure the actual graft diameter after FLEK.

From the Center for Ophthalmic Optics and Lasers, Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Received for publication November 27, 2009; revision received June 28, 2010; accepted August 10, 2010.

Supported by National Institutes of Health grants R01 EY018184, EY017723, and P30 EY03040; a grant from Optovue, Inc; and the Charles C. Manger III, MD Chair in Corneal Laser Surgery endowment.

Disclosures: M. Tang and D. Huang receive grant support from Optovue, Inc. D. Huang also received patent royalty, stock options, speaking fees, and travel support from Optovue, Inc. D. Huang receives patent royalty from the Massachusetts Institute of Technology related to optical coherence tomography technology licensed to Carl Zeiss Meditec, Inc. M. Heur and S. Yiu have no disclosures.

Reprints: David Huang, Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, DEI 5702, Los Angeles, CA 90033 (e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.