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D. T. Tan, A. Parthasarathy, R. J. Beuerman, H. Cajucom-Uy, J. S. Mehta, Y.-M. Por; Femtosecond Laser-Assisted Endothelial Keratoplasty (FLEK) - Morphological and Scanning Electron Microscopic Evaluation of Donor Cornea Posterior Lamella Preparation With the Femtec 20/10 Perfect Vision Femtosecond Laser. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1129.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) requires posterior lamellar donor preparation with use of a microkeratome-artificial chamber device. We developed a new procedure to prepare the lamellar donor tissue, using the femtosecond laser. This study evaluates feasibility, ease of performing femtosecond laser-assisted ablation, donor and surface bed morphology.
Femtosecond laser algorithms utilizing the FEMTEC laser were developed to perform a 7.5mm diameter posterior lamellar dissection at 150 microns from descemet's membrane, with a peripheral rim cut enabling complete detachment of the posterior lamella. Six human eye bank corneas were used; 2 received single lamellar ablation pass, 2 a double pass and 2 a triple pass, at the same optimized laser parameters. Subjective clinical grading; ease of rim separation, posterior lamellar separation and appearance of lamellar surface quality was performed by a single observer. Tissues were fixed and processed for SEM (JEOL JSM-5610LV) using standard protocol. Masked independant observers graded the SEM images of stromal bed of the donor disc and corneoscleral rim from 1(poor) to 4(excellent) for surface smoothness.
Single pass ablations resulted in poor donor separation and surface regularity relating to stromal tearing during removal of the donor lamella. In contrast, double and triple pass ablations resulted in significantly improved donor separation, with minimal manipulation. Triple pass ablations were marginally superior to double in the ease of separation. Mean score of SEM for the stromal bed of the donor disc was 4 for double/triple pass and 2.25 for single pass (p=0.046). Mean score of SEM for stromal bed on corneoscleral rim was 2.25 for single pass and 3.1 for double/triple pass. SEM and reflected light microscopy findings confirmed that the double/triple pass lamellar bed morphology was superior to that of a single pass with minimal disruption of the corneal lamellae, no tissue tags or ridges and smooth dissection of the bed.
Femtosecond laser can be used to prepare the donor corneal lamellae for DSEK. Double cut and triple pass lamellar ablations provide good tissue separation and bed surface quality. Femtosecond laser-assisted endothelial keratoplasty (FLEK) appears to be a feasible alternative to microkeratome assisted DSEK surgery.
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