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Tatiana Prazeres, Flavio E Hirai, Luciene Barbosa, Rodrigo Santos, Mayumi Nakano; A Confocal Study analysis in Deep anterior lamellar keratoplasty (DALK) using Femtosecond laser associated to Big Bubble technique to compare donor corneas with the removal or not of Descemet’s membrane and endothelium. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2032.
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To compare the visual acuity (VA), clinical findings and confocal microscopic features in patients with keratoconus submitted to DALK using donor corneal tissue with the removal or not of Descemet’s membrane and endothelium.
This prospective trial conducted at Sorocaba Eye Hospital and Federal University of São Paulo enrolled 11 patients diagnosed with Keratoconus submitted to DALK procedure using Femtosecond assisted laser associated with big bubble technique. Two patients missed the apointment and the 09 reamain patients were randomized in 2 groups: 1- using donor cornea with descemet’s membrane and endothelium and 2- using donor cornea without descemet’s membrane and endothelium. Pre operatory evaluation were visual acuity, tonometry, biomicroscopy, topography and paquimetry. Post operatory evaluation were visual acuity wearing contact lenses, biomicroscopy and confocal microscopy study
Imaging analysis on confocal microscopy at 7 days post operatively,showed higher density of small, round hyper-reflective corpuscles throughout the donor graft in all corneas in which the donor endothelium was removed. Some eyes also presented receptor endothelial folds. "Quieter" stroma was observed in the group the endothelium was preserved. In this same corneas, the donor endothelium could be observed in some eyes. Overall count of keratocytes in the stroma seemed to be low in both groups.
In both groups, keratocyte counts were altered following DALK procedures. In the corneas in which DM and endothelium were removed (group 1), cellular changes in donor tissue and receptor endothelial folds were observed. We hypothesize that the observed alterations in the corneas with removed donor endothelia may be the result of mechanical trauma to the tissue.
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