Femtosecond Laser-Assisted Pterygium Surgery Using a Customized Algorithm for Trapezoidal Conjunctival Grafts

Conjunctival autografts (CAGs) are the gold standard treatment after pterygium resection, but it is challenging to achieve consistently thin Tenon-free CAGs with manual dissection. We herein report the reproducibility and clinical outcomes of a novel algorithm to produce customizable trapezoidal CAGs using femtosecond laser (femtosecond lasers)-assisted pterygium surgery.

We first tested this algorithm in 4 pig eyes to show reproducibility. We then treated 15 pterygia of 14 patients using this algorithm. After manual pterygium excision, 7-mm x 10-mm preset trapezoidal CAGs were dissected with the Ziemer FEMTO LDV Z8 laser set at a 60 μm depth. The achieved thickness was measured with intraoperative optical coherence tomography, and the achieved area was calculated.

For the pig eyes, the average CAG length and width were 9.8 ± 0.1 mm and 7.3 ± 0.04 mm, respectively, with a mean deviation of 7.3% ± 3.2% and 7.5% ± 4.1%, respectively. The mean age of the patients was 56.8 ± 7.3 years. The programmed and achieved CAG areas were 70 mm 2 and 72.5 ± 3.9 mm 2 , respectively, with a mean deviation of 4.7% ± 4.6%. The eventual CAG thickness was 59.5 ± 3.9 μm, with a minimal deviation of 4.4% ± 4.6%. The average time to remove the FSL-prepared CAG to unfold it onto the cornea was 19.9 ± 14.9 seconds. At the postoperative month 3 follow-up, no postoperative complications or recurrences occurred, and all donor CAG sites had completely healed.

This novel algorithm using the FEMTO LDV Z8 in Femtosecond Laser-Assisted Pterygium Surgery provides consistent and customizable trapezoid ultrathin CAGs. Longer follow-up and larger cohorts will need to be studied for recurrence and complication rates.