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Y. Y. Cheng, E. Pels, L. J. Müller, R. J. van Suylen, J. P. M. Cleutjens, P. M. Frederik, R. M. M. A. Nuijts; Preparation of Posterior Lamellar Discs (PLD) With Femtosecond (FS) Laser Technology for Descemet Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4713.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the safety and feasibility of the FS laser for the preparation of posterior lamellar discs for Descemet Stripping Endothelial Keratoplasty.
The FS laser (IntraLase Corp., Irvine, CA) was used to prepare a lamellar cut in fourteen corneas of human donor eyes. A horizontal lamellar cut was prepared in the donor cornea with a FS laser (15kHz or 30kHz) using a raster and/or spiral spot pattern. After FS laser preparation of a 9.5 mm wide lamellar cut at a depth of 400 micron, the corneoscleral button was stored in organ culture medium. Endothelial cell (EC) density was evaluated before and after preservation in organ culture. EC loss was compared to the non-FS laser-treated paired corneas. The PLD was stripped from the anterior part using either a forceps or a blunt dissection technique. The damage to the endothelium was evaluated using vital staining techniques. Scanning electron microscopy was used to calculate the thickness of the PLD.
There was no significant difference in EC loss between FS and non-FS laser treated corneas after organ culture in the 15 kHz (7.7 ± 6.9% and 8.9 ± 8.1%, respectively, P = 0.779) and 30 kHz groups (4.3 ± 4.0% and 3.7 ± 3.6%, respectively, P = 0.753). There was no significant effect of laser frequency (15 kHz vs 30 kHz) on EC loss (P = 0.282). Dissection using a forceps stripping technique resulted in higher EC loss as compared to a blunt dissection technique (13.0% vs 6.5%, P = 0.028).The relative depth of the lamellar cut in the cornea was at 47.0 ± 5.0% of the total corneal thickness.
There was no significant EC loss after FS laser PLD preparation as compared to non-treated paired corneas. A blunt dissection technique of PLDs resulted in an acceptable EC loss and the depth of the FS laser lamellar cut correlated well with the predicted depth. These findings support the clinical use of the FS laser for the preparation of PLDs.
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