Faculty Collaboration Database

Manual suction versus femtosecond laser trephination for penetrating keratoplasty: intraocular pressure, endothelial cell damage, incision geometry, and wound healing responses. Invest Ophthalmol Vis Sci 2012 May 04;53(6):2571-9

Date

03/20/2012

Pubmed ID

22427557

DOI

10.1167/iovs.11-8403

Scopus ID

2-s2.0-84860642599 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

PURPOSE: To measure real-time intraocular pressure (IOP) during trephination with a manual suction trephine (MST) and the femtosecond laser (FSL), and to assess endothelial cell damage, incision geometry, and wound healing response with these procedures.

METHODS: IOP was monitored with an intracameral sensor. Eight rabbits underwent manual suction trephination. Eight rabbits had FSL trephination (FSL-T). Slit lamp photography, confocal microscopy, and anterior segment optical coherence tomography (AS-OCT) were performed at baseline and postoperatively. Animals were sacrificed at 4 hours and 3 days. Tissue was examined with scanning electron microscopy (SEM) and immunohistochemistry for an array of wound-healing markers. Separately, 6 human corneas had MST (3) and FSL-T (3). Incision geometry was imaged with high resolution Optovue AS-OCT.

RESULTS: The average IOP during MST and FSL-T was similar (37 mm Hg). There was wider IOP fluctuation during the MST cutting phase (60 mm Hg maximum). There were 1-2 rows of endothelial loss on either side of the incision for FSL-T and 2-5 rows deep for MST. Immune cell responses at 4 hours (CD11b) were comparable, greater apoptosis with FSL-T (TUNEL) occurred at 4 hours, and there was increased keratocyte proliferation at 3 days (Ki67) with FSL-T. There was significantly greater undercutting of the cornea with MST (46.86 degrees versus 16.72 degrees).

CONCLUSIONS: There is more IOP variation during MST. Average IOP is 37 mm Hg for both techniques. More endothelial damage and undercutting of the cornea occurs with MST. The wound healing response to FSL-T appears greater at 3 days.

Author List

Angunawela RI, Riau A, Chaurasia SS, Tan DT, Mehta JS

Author

Shyam S. Chaurasia PhD Associate Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Animals
Biomarkers
Cell Count
Cornea
Corneal Endothelial Cell Loss
Endothelium, Corneal
Female
Fluorescent Antibody Technique, Indirect
Humans
In Situ Nick-End Labeling
Intraocular Pressure
Keratoplasty, Penetrating
Laser Therapy
Male
Microscopy, Electron, Scanning
Middle Aged
Rabbits
Suction
Tomography, Optical Coherence
Wound Healing
Young Adult