Matthias Fuest1, Yu-Chi Liu, Minas T Coroneo, Jodhbir S Mehta. 1. *Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore; †Department of Ophthalmology, RWTH Aachen University, Aachen, Germany; ‡Singapore National Eye Centre, Singapore; §Department of Ophthalmology, University of New South Wales, Australia; ¶Eye-ACP, Duke-NUS Graduate Medical School, Singapore; and ‖School of Material Science and Engineering, Nanyang Technological University, Singapore.
Abstract
PURPOSE: Pterygium is a prevalent ocular surface disorder. Conjunctival autografting (CAG) after pterygium resection is the gold standard treatment. Thinner CAGs without Tenon tissue provide better results but are technically difficult to achieve. We report on the first femtosecond laser (FSL)-assisted pterygium surgery (FLAPS) in humans. METHODS: In a clinical trial, we treated 6 eyes of 5 patients with FLAPS. After manual removal of the pterygium, CAGs were dissected with the Ziemer Z8 at 60-μm depth and glued into the resection defect. CAG thickness and diameter were measured. RESULTS: The CAG area measured 17.9% smaller than the laser settings (P = 0.03). Central (75.6 ± 13.7 μm) and peripheral (77.7 ± 13.2 μm) CAG thickness did not differ significantly (P = 0.3). No buttonholes or CAG tags occurred. The mean dissection time was 19.5 ± 1.2 seconds, and the time to remove the FSL-prepared CAG and to unfold it onto the cornea was 10.3 ± 3.8 seconds. During 35.8 ± 38.0 days of follow-up, no postoperative complication or recurrences occurred. The conjunctival epithelium had healed at the CAG resection site within 1 week with no evidence of scarring. CONCLUSIONS: FLAPS is a new technique, in which the preparation of an ultrathin CAG is done by the FSL. After optimization in porcine eyes, the clinical trial in the first 6 eyes was performed without any complications and the FSL might assist in further standardizing the surgical procedure. Longer follow-up and larger cohorts are needed to assess recurrence rates.
PURPOSE: Pterygium is a prevalent ocular surface disorder. Conjunctival autografting (CAG) after pterygium resection is the gold standard treatment. Thinner CAGs without Tenon tissue provide better results but are technically difficult to achieve. We report on the first femtosecond laser (FSL)-assisted pterygium surgery (FLAPS) in humans. METHODS: In a clinical trial, we treated 6 eyes of 5 patients with FLAPS. After manual removal of the pterygium, CAGs were dissected with the Ziemer Z8 at 60-μm depth and glued into the resection defect. CAG thickness and diameter were measured. RESULTS: The CAG area measured 17.9% smaller than the laser settings (P = 0.03). Central (75.6 ± 13.7 μm) and peripheral (77.7 ± 13.2 μm) CAG thickness did not differ significantly (P = 0.3). No buttonholes or CAG tags occurred. The mean dissection time was 19.5 ± 1.2 seconds, and the time to remove the FSL-prepared CAG and to unfold it onto the cornea was 10.3 ± 3.8 seconds. During 35.8 ± 38.0 days of follow-up, no postoperative complication or recurrences occurred. The conjunctival epithelium had healed at the CAG resection site within 1 week with no evidence of scarring. CONCLUSIONS: FLAPS is a new technique, in which the preparation of an ultrathin CAG is done by the FSL. After optimization in porcine eyes, the clinical trial in the first 6 eyes was performed without any complications and the FSL might assist in further standardizing the surgical procedure. Longer follow-up and larger cohorts are needed to assess recurrence rates.