Метод двойного позиционирования при глубокой передней ламеллярной кератопластике с помощью фемтосекундного лазера: ретроспективное исследование серии последовательных случаев запущенного кератоконуса

Double-Docking Technique for Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty: A Retrospective Consecutive Case Series Study of Advanced Keratoconus.

Deep anterior lamellar keratoplasty (DALK) is a surgical technique used to treat corneal stromal disorders, such as keratoconus. DALK has several advantages over penetrating keratoplasty (PK), especially for the limited rate of rejection.^1,2 The big-bubble (BB) technique was described by Anwar and Teichmann³ to dissociate Descemet membrane from the posterior stroma during DALK. Although this technique allows optimal vision recovery, the BB technique is associated with a steep learning curve. The depth of air injection (∼100 μm above the endothelial layer⁴) was associated with a favorable outcome for BB formation. However, the insertion of a cannula or a needle close to Descemet membrane presents a risk of perforation, which frequently requires conversion to penetrating keratoplasty (PK). To improve the reproducibility of DALK, a femtosecond laser (FSL) was used for the precision of the incisions.^5–18 We previously described a technique using FSL and intraoperative OCT to assist surgeons during surgery.⁵ This technique was coined as the double-docking technique for FSL-assisted DALK (DD-DALK). FSL with intraoperative OCT enables the first lamellar resection to be performed under direct visual control (first docking), limiting the risk of corneal perforation that could occur when using a manual trephine. This lamellar resection also allows the needle or cannula to be positioned close to Descemet membrane, a prerequisite for successful BB formation.⁴ After BB formation, a second docking was performed to cut the residual irregular posterior stroma with the FSL, which was subsequently removed using forceps. This second docking to remove the residual stroma minimizes surgical dissection, thereby improving the learning curve for this difficult technique. In this study, we present the results of DD-DALK in patients with advanced keratoconus and the predictive factors associated with BB formation.