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Jean-Louis Bourges, Michele Savoldelli, Francine F Behar-Cohen; Interfaces of femto-assisted endothelial keratoplasty. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4722.
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to analyze the area of altered collagen layer at graft’s interface of femto-assisted endothelial keratoplasty (FLEK)
We collected corneas from patients who underwent penetrating keratoplasty after failed FLEK and observed graft’s interface by transmission electron microscope (TEM). Ten pictures were captured from TEM observation fields within the 3 mm central area for each cornea. Collagen fibers and fibrillae were observed. The interface area were isolated and the thickness of damaged collagen was semi-quantified within 5 groups ( G1<1µm, G2=1 to 5 µm, G3>5 to 10µm, G4>10µm to 15µm and G5>15 µm).
Four corneas were analyzed (4 patients, 2 post-rejection failures, 1 secondary endothelial failure, 1 poor visual recovery). The average (±SD) interface length studied was 96.9±12µm. At the graft’s interface, disrupted collagen fibrillae were systematically observed whereas recipients displayed normal arrangement of lamellae. The average lengths of the disrupted collagen layer on TEM fields were G1=4.1±11.9 (4%); G2=34±39.2 (33%); G3=26.8±31.1 (26%); G4=23.6±30.8 (26%); G5=8.5 20.3 (10%). An irregular arrangement of collagen lamellae was observed in 3/4 corneas.
A collagen lamellae rearrangement and significant collagen fibrillae disruption is observed after FLEK on the graft’s side of the interface. It could likely participate in the poor visual outcomes reported after femto-assisted DSEK.
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