2 get laser cornea transplants

Two patients at the Moran Eye Center at the University of Utah have now received laser-based cornea transplants.

Dr. Majid Moshirfar, cornea disease and refractive surgery specialist, is the first Utah eye surgeon to use IntraLase-Enabled Keratoplasty, a laser that makes corneal incisions for full-thickness corneal transplants.

The cornea is the clear tissue in front of the pupil made of crystaline material that looks like a dome. Degeneration, scarring and other conditions can cause it to cloud up so it can't be seen through, like a dirty window. Cornea transplant — the most common form of transplant in the United States, with about 32,000 done a year — restores vision.

One of the challenges has been how the damaged piece of cornea is removed and a new piece, usually donated through an eye bank, is put in its place. For years, surgeons have used a Trephine Corneal Cutter, which Moshirfar describes as a "cookie cutter" to manually remove the corneal tissue. Then the new cornea is sewn into place with stitches that will remain in the eye for a year or more. It also takes about that long for full vision recovery after the transplant.

The new procedure, said Moshirfar, lets the surgeon "precisely, accurately tell the machine" what size and even what shape trephine is needed, as well as the depth to go into the cornea. "We can make it on the sides look like a zigzag or straight or more like a funnel. We can precisely cut both donor tissue and host tissue with greater precision."

That precision means fewer stitches to hold the new cornea in place, he said. And the sutures can be removed sooner, speeding healing. It also means less chance of creating a stigmatism. Patients get some good visual acuity by three months, instead of the traditional year.

It doesn't change the length of the surgery itself — at least not yet. A cornea transplant takes about 80 minutes. Moshirfar said it may, in the future, be possible to "interlock" the new tissue into the eye, like a jigsaw puzzle piece, so no sutures at all are needed. The variable tension of the stitches can create stigmatism, a problem that would also be helped if no stitches were used.

IEK uses a computer-guided ultrafast femtosecond laser to create the incisions. Because of their precise shapes and the ability to interlock them, the graft is more stable and heals faster.

Most patients, following cornea transplant, require rigid gas permeable contact lenses to correct vision and reduce stigmatism. The laser seems to promise they'll be able to use regular glasses or soft contact lenses for vision correction if needed, he said.

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