Comparison of Wound Integrity of Clear Corneal Incisions Created Using Keratome or Femtosecond Laser

Sunday, April 19, 2015: 3:34 PM
Room 5B (San Diego Convention Center)
Harvey S. Uy, MD
R. Ty Olmstead, PhD

Evaluate and compare wound integrity and sealing properties of clear corneal incisions (CCI) created with a 2.2 mm keratome or a femtosecond laser, among eyes undergoing refractive laser assisted cataract surgery (RELACS).

Prospective randomized clinical trial of 62 eyes undergoing RELACS.  The CCI was created using either a 2.2 mm keratome (n=31) or a femtosecond laser (Lensar, Orlando, FL) (n=31).  Phacoemulsification was performed by a single surgeon.  At the conclusion, after removal of the irrigation/aspiration probe, the eyes were graded  as follows:  Grade 1, flat anterior chamber (AC) needing CCI wound hydration (WH) and AC reformation via paracentesis wound;  Grade 2, flat AC not needing WH but needing AC reformation.; Grade 3, formed AC not needing WH nor AC reformation.    Main outcome measure: mean wound grade per incision type.

Both treatment groups were comparable in terms of patient age,  nuclear density, cumulative dissipated energy, operative time.   The mean (SD) wound seal grade for the keratome group was 1.32 (0.65) and for the laser group, 2.35 (0.84) (P < 0.0001).  In the keratome group, the frequency of eyes with wound grade of 1, 2 and 3 was 77%, 13%, 10%, respectively; while in the laser group, 23%, 19%, 58%, respectively.  None of the eyes developed significant postoperative wound-related complications.

Both methods created CCI with adequate wound integrity.  Overall, the laser CCI wounds appear to demonstrate better wound closure reliability and greater ability to self-seal.