Femtolaser-assisted refractive autokeratoplasty in the management of advanced keratoconus (Three-years outcomes)

Abstract

Purpose-To evaluate the long-term results of a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in the management of advanced keratoconus. Material and methods. The study included 45 patients with stable advanced keratoconus (31 males, 14 females; stage III of the disease-5 eyes, stage IV-40 eyes). All patients were operated and observed at the 10th Minsk City Hospital (the follow-up period varied from 12 months to 3 years). Mean age was 33.8±10.1 years (16 to 55 years). Uncorrected visual acuity (UCVA) was 0.07±0.03 (0.02 to 0.1). FRAK was performed with the use of the femtolaser device «Intra-Lase 60 kHz». The principal idea behind the new method is reshaping patient’s conically changed cornea by performing a 2-step resection of corneal stroma, removing the tissue flap and suturing. Results. UCVA significantly improved from 0.07±0.03 to 0.26±0.11 at 12 months after the surgery (from 0.08 to 0.5). UCVA varied from 0.2 to 0.5 in 77.8% of patients (р<0.05). Mean best corrected visual acuity (BCVA) was 0.4±0.18 (0.2 to 0.7) in 24-36 months postoperatively. The indices of keratotopography significantly improved: Ks 49.8±4.7 D, Kf 44.2±5.19 D, Cyl 4.8±1.9 D, Kmax 53.7±3.9 D (р<0.05). 82.2% of patients were satisfied with resulting visual acuity. Conclusion. Long term results of FRAK prove that this method allows reshaping of optical zone of the cornea in advanced keratoconus, improving both UCVA and BCVA while avoiding corneal transplantation and improving the quality of patient’s life.