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Luca Menabuoni, Annalisa Canovetti, Alex Malandrini, Ivo Lenzetti, Francesca Rossi, Roberto Pini; Improvements In Laser-based Dsaek Technique: Femtosecond Laser Descemetorhexis And Stabilization Of The Flap With Diode Laser Welding. Invest. Ophthalmol. Vis. Sci. 2012;53(14):32.
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© ARVO (1962-2015); The Authors (2016-present)
In this work we show an original approach developed to improve the postoperative results in DSAEK. The donor flap is prepared with the use of a femtosecond (fs) laser (iFS 150, Abbot-AMO); in the recipient eye the same fs laser is used to prepare a descemetorhexis; lastly the transplanted flap is stabilized in the final position with the use of the laser welding technique.
The donor cornea is examined by OCT in the surgery room and, by the use of the fs laser a 120 micrometer thick descemetic-endothelial lamella is prepared. With the same laser a side cut is obtained in the recipient eye, having the same diameter (8.5 mm) of the donor tissue; two penetrating tunnels are sculptured with 1 mm width and 5 mm distance from the central cornea. These two entries will be used to evacuate the residual water that may be between recipient and donor tissues. The descemetorhexis in the recipient eye is performed following the laser pattern. The donor flap is then positioned onto the Busin injector. The stromal side of the same flap is stained with Indocyanine Green water solution, paying attention in treating only the peripheral portion of the tissue. Then the donor tissue is inserted and positioned. The tunnels are closed with standard suturing; an air bubble is introduced in anterior chamber and the residual water enclosed between the transplanted flap and the recipient eye flows away through the apertures. The flap is then laser welded to the patient eye by the use of the pulsed diode laser welding procedure.
This technique is simple to set up and it allows a perfect descemetorhexis and positioning of the transplanted flap. The welding technique enables the stabilization of the flap position.
The proposed procedure is effective, reliable and simple to set up. By the use of this approach the intraoperative and postoperative DSAEK issues are improved.
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