Improvement Of Endothelial Keratoplasty Lamellar Dissection By Combined Use Of Femtosecond And Excimer Lasers

Abstract

Purpose: : To describe a new technique of endothelial keratoplasty (EK) by improving the quality of lamellar dissection of donor cornea.

Methods: : We compared 4 techniques of corneal preparation for lamellar dissection on 8 donor corneas: 1) mechanical dissection with microkeratome, 2) single femtosecond laser lamellar cut, 3) double femtosecond laser lamellar cut and 4) combined femtosecond laser lamellar dissection with excimer laser surface photoablation. Quality of donor cornea interface was assessed and compared between the 4 techniques using scanning electron microscopy (SEM).

Results: : The smoothest stromal interface was observed on SEM with the combined used of femtosecond laser dissection and excimer photoablation followed by mechanical microkeratotomy, double femtosecond laser lamellar cut and single femtosecond laser lamellar dissection.

Conclusions: : We suggest a new technique for lamellar dissection of endothelial graft, the Femtosecond and Excimer Lasers Endothelial Keratoplasty (FELEK), which resolves current limits observed in Descemet-stripping automated endothelial keratoplasty (DSAEK). Femtosecond laser dissection provides a thin and reproducible endothelial graft cut with a high safety and accuracy while excimer photoablation yields a regular interface of good quality.

Keywords: cornea: endothelium • imaging/image analysis: non-clinical • microscopy: electron microscopy