Figure 1 - uploaded by Beniamin Oskar Grabarek
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Stages of the deep anterior lamellar keratoplasty (DALK) surgical procedure. (1) Hesburg-Baron vacuum trepan applied to the center of the cornea; (2) cornea incised to a depth of 80% of the corneal dermis; (3) 27G needle bent at a 30° angle before insertion into the corneal dermis; (4) corneal dermis dissected with air; (5) Descemet's membrane dissected; (6) patient's eye after completed anterior layered corneal transplantation.
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Background: This prospective study, from a single center in Poland, aimed to evaluate the correction of residual ametropia, or refractive errors, after corneal grafting using femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) in 60 patients (96 eyes) who had previously undergone deep anterior lamellar keratoplasty (DALK) compared with...
Context in source publication
Citations
... Nevertheless, visual acuity often remains unsatisfactory [33]. Other approaches mentioned in the present study include surgical procedures such as suture tightening or selective suture removal as well as novel blunt dissection technique [5], intracorneal ring segments (ICRS) including Ferrara-type ICRS implantation [14,22], femtosecond laser-assisted ICRS implantation [13,14,19,24,34], relaxing incisions [23], corneal wedge resection [12,18], photorefractive keratectomy (PRK) [17], and deep intrastromal arcuate keratotomy with in situ keratomileusis (DIAKIK) [20]. ...
... According to the majority of current studies, femtosecond-assisted keratotomy appears to be a safe and effective method for significantly reducing corneal astigmatism. Also, there is substantial literature evidence that femto-LASIK is the most successful indication for management of postoperative astigmatism after corneal keratoplasty with excellent outcomes [13,14,16]. In the present studies, the UDVA improved significantly in all eyes at 6 months of femto-LASIK. ...
... Forest plot for visual acuity change using fixed-and random-effects model[5,6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31]. ...
Background: The number of corneal transplants is rising, with the aim to treat a spectrum of diseases ranging from dystrophies to corneal opacities caused by trauma or chemical burns. Refractive outcomes after this procedure are often impossible to predict and associated with high levels of astigmatism. However, there are many techniques that affect the reduction of astigmatism and improve the quality of life of patients. Objectives: The aim was to compare the improvement in postoperative visual acuity (logMAR) and amount of corneal astigmatism (Diopters) after corneal keratoplasty in patients who additionally underwent a surgical procedure, which affects the reduction in postoperative astigmatism, and to determine the most effective method. Search Methods and Selection Criteria: A thorough search was carried out across online electronic databases including PubMed, Embrase, Ovid MEDLINE, Scopus, and Web of Science, using combinations containing the following phrases: postoperative astigmatism, post-keratoplasty astigmatism, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), posterior lamellar keratoplasty, endothelial keratoplasty (EK), penetrating keratoplasty (PK), corneal transplant, keratoplasty, refractive surgery, kerato-refractive surgery, laser in situ keratomileusis (LASIK), and femtosecond LASIK. This was to determine all English-language publications that discuss refractive operations for postoperative or post-keratoplasty astigmatism. These bibliographies were searched for English-language publications published between 2010 and 2023. We proceeded to review each detected record’s reference list. Data Extraction: Study characteristics such as study design, sample size, participant information, operations performed, and clinical outcomes were all extracted. Data Statistical Analyses: The Comprehensive Meta-Analysis software (version 3.3.070, 2014) was used to perform the analysis. The threshold of 0.05 for p-values was considered statistically significant. All effect sizes are reported as standardized differences (Std diff) in means with a 95% confidence interval (CI) and visualized graphically as forest plots. Publication bias is presented as a funnel plot of standard error by Std diff in means. Four methods were used to evaluate the heterogeneity among the studies: Q-value, I², chi-square (χ²), and tau-squared. Main Results: We included 21 studies that randomized 1539 eyes that underwent corneal transplantation surgery either by PKP, DALK, or DSEAK techniques. The results showed the most significant improvement in the visual acuity and significant decrease in the corneal astigmatism after laser surgery procedures, like femtosecond-assisted keratotomy after DALK and PKP and LASIK after DSEAK.
