Manual Vs FS Keratoplasty Tamer M. El-Raggal, MD, PhD, FRCSEd Professor of Ophthalmology Ain Shams University ESOIRS 2014 Types of trephines & punches : • True Manual (first1905) • Suction (70-130 $) • Mechanised (preset) ESOIRS 2014 •Low cost •Easy •Fast •Reproducible ESOIRS 2014 FS Machines • Expensive (700.000 $) • Patient interface (140 -200 $) x 2 • Extra room ESOIRS 2014 NOT SUITABLE IN: Many patients are not candidates • Tectonic (Descematocele, perforation) • Irregular surface • Difficult obtain and maintain suction e.g. bleb • Previous incisional corneal surgery ESOIRS 2014 NOT SUITABLE IN: Inability to obtain adequate laser trephination • Oedematous grafts • Scarred corneal periphery ESOIRS 2014 DISADVANTAGES IN PKP •Learning curve •Increased duration of surgery (>30 min) •Vacuum loss during procedure —— Manual (graft already cut) •2 rooms —— premature AC open —— infection (remote location of laser machine) ESOIRS 2014 • Complete wound —— Wound rupture ———Suprachoroidal hge during patient transfer ESOIRS 2014 •Anaesthesia: Peri/retrobulbar block with partially trephined cornea •Artificial AC — more instruments —— more (expenses + infection) •Donor epithelial & endothelial injury ESOIRS 2014 • Complexity of equipments & need for trained staff ESOIRS 2014 • Completed with scissors ESOIRS 2014 • Long time pressure (>5 min.) — glaucoma ESOIRS 2014 ESOIRS 2014 •More exact suture depth placement •Difficult suturing —— Poor closure ESOIRS 2014 • Less sutures —— astigmatism ESOIRS 2014 ESOIRS 2014 Decagonal keratoplasty ESOIRS 2014 ESOIRS 2014 DISADVANTAGES IN DALK •No DM baring •Stromal interface haze ESOIRS 2014 ESOIRS 2014 DISADVANTAGES IN DSAEK •No DM stripping •Stromal interface haze ESOIRS 2014 •Incomplete dissection (donor tissue damage) •Endothelial damage (direct energy) ESOIRS 2014 No DMEK & No PDEK ESOIRS 2014 Conclusion • While FS laser ser offers advantage of more precise incisio incision creation for LK & PK, disadvantages sadvantages associated with its use limited iits widespread use. • It remains to be seen whether FS laser represen represents “future” of incisional corneal orneal surgery ??? • We must be e cautious in application of this technology, remembering that still “a work in progress”. ESOIRS 2014 THANK YOU ESOIRS 2014