The purpose of this article is to describe the femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK) technique in detail, comparing the clinical efficacy of the Femto-DALK technique with added photoablation (modified technique), versus Femto-DALK alone, in patients with advanced keratoconus. The study included 24 eyes of 12 patients, average age 30 years, with advanced keratoconus.
One group of 12 eyes were given Femto-DALK plus laser excimer photoablation (PRK Optical Zone 5-9mm, and central PTK) with AMO\'s VISX STAR S4 IR EXCIMER LASER ®. The other group of 12 eyes were given Femto- DALK only with the ZIEMER Z6 ®, used in all cases. Better corrected visual acuity (BCVA), keratometry (K1-K2), using Tomey TM5®, subjective refractiveness, ultrasound-measured corneal pachymetry and OPTOVIEW ® anterior segment OCT, was recorded in the immediate postoperative period, 3, 6 and 12 months of follow-up.
In all cases the same surgeon made a straight cut at 80% of the depth of the central corneal pachymetry, as measured by OCT. In the aggregate photoablation group, PRK of +6 diopters was performed on the periphery, and a central PTK of 40 microns was performed on the residual stromal bed. Both groups were sutured with 12 separate stitches. The results are described per year of the procedure.
Both Femto-DALK alone and Femto-DALK plus photoablation are safe surgical techniques for the treatment of advanced keratoconus, however, the modified technique showed better results (p<0.01 T student test). However, more cases and follow-up time are required.
Rodolfo A. Pérez Grossmann,
Luis A. Villa Cabrera,
Rodolfo A. Pérez Simons
Objective: To present a case of secondary glaucoma to increased venous pressure in a patient with Radius- Maumenee Syndrome.
Background: A patient with no family history of glaucoma arrives with open-angle glaucoma and mild sporadic episodes of ocular congestion in the affected eye.
Case Description: Female patient, presented with increased intraocular pressure (IOP) in the right eye (RE) (26 mm Hg) with prominence of the episcleral vessels, open angle and in the gonioscopy the presence of blood in Schlemm\'s canal with increased the excavation of the optic nerve (0.7/0.6); the left eye (LE) is within normal limits.
Conclusion: A case of secondary glaucoma is presented to increased episcleral venous pressure or Radius-Maumenee syndrome.
Clinical Importance: The clinical case shows us the importance of venous pressure in the development of glaucoma. This alteration in the venous flow in this particular case highlights the influence of the collector channels and the anastomoses that it may have with the intrascleral venous plexuses and later of the aqueous veins with the subconjunctival and episcleral venous plexuses in the development of glaucoma.
The new technology of the 3D system has allowed cataract surgery to be performed with head free of microscope. The advantages are many such as better posture of the surgeon, greater depth of focus, magnification of the image, less exposure to light, among others