Since their introduction, pIOLs have successfully corrected a wide range of refractive errors; nevertheless, some sight-threatening complications were presented with the earliest models. The continuous improvement of pIOLs models has successfully diminished the presence of complications, which still rarely occur. In this chapter, we will review the intraoperative and postoperative complications of each pIOL model.
Femtosecond laser dissection is explained by the optical breakdown and photodisruption, which induce the creation of extremely precise incisions by separating lamellar fibers within the stroma of the corneal tissue. Nowadays, femtosecond laser technology is used during keratoplasty procedures in order to perform corneal dissection and incisions during the surgery. Even when recent scientific publications have reported that there is no clear benefit when using femtosecond laser over conventional keratoplasty procedures, many other studies demonstrate that femtosecond laser-assisted keratoplasty can perform corneal incisions, which provides better tissue coaptation, biomechanical stability optimizing clinical results, reduce the number of sutures and earlier suture removal compared to mechanical surgery. Future perspectives show the potential of femtosecond-assisted surgery to improve wound healing and vision recovery. An increasing number of trials are underway to develop more desirable cutting shapes to allow surgeons to perform early suture removal and reduce the amount of astigmatism related to keratoplasty procedures.
Corneal transplantation is the most commonly performed human tissue transplantation procedure worldwide. Because of the large number of transplants, corneal graft failure has become one of the most common indications for corneal transplantation. The relatively recently developed lamellar transplant techniques have brought about specific potential complications leading to graft failure that may require different approaches to repeat transplantation other than penetrating keratoplasty (PK). On the other hand, these new lamellar techniques also provide novel ways of rescuing failed penetrating grafts, with potential advantages over successive PKs, such as reduced intraoperative risks and faster visual rehabilitation. In the current chapter, we will summarize the incidence and risk factors of graft failure for penetrating corneal transplants and discuss the various surgical alternatives currently available to rescue such failed grafts, with a focus on the reported outcomes and limitations.
In the following chapter, we will describe the outcomes of femtosecond laser-assisted tuck-in penetrating keratoplasty (PKP) as a single-step surgical procedure for the visual and anatomical rehabilitation of patients with severe keratoglobus and endothelial damage, where regular tuck-in lamellar techniques are not an option. The only alternative surgical approach would be an epikeratoplasty followed by a central PK which would involve two surgeries and a very long visual recovery in these usually young patients with the potential risk of amblyopia. On the other hand, Femtosecond laser permits an accurate dissection of these already thin corneas without inadvertent perforation risk.
