May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Comparison of Posterior Stromal Bed Dissection: Microkeraome vs. Femtosecond Laser
Author Affiliations & Notes
  • D. T. Tan
    Ophthalmology, Singapore Natl Eye Ctr/Singapore Natl Un, Singapore, Singapore
  • J. S. Mehta
    Ophthalmology, Singapore Natl Eye Ctr/Singapore Eye Research Institute, Singapore, Singapore
  • Y. M. Por
    Ophthalmology, Singapore Natl Eye Ctr, Singapore, Singapore
  • H. Cajun-Uy
    Ophthalmology, Singapore Natl Eye Ctr/Singapore Eye Research Institute, Singapore, Singapore
  • A. Parasarthy
    Ophthalmology, Singapore Natl Eye Ctr, Singapore, Singapore
  • R. W. Beuerman
    Ophthalmology, Singapore Eye Reseach Institute/Singapore Natl Un, Singapore, Singapore
  • Footnotes
    Commercial Relationships  D.T. Tan, None; J.S. Mehta, None; Y.M. Por, None; H. Cajun-Uy, None; A. Parasarthy, None; R.W. Beuerman, None.
  • Footnotes
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Investigative Ophthalmology & Visual Science May 2008, Vol.49, 1149. doi:
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    • Get Citation

      D. T. Tan, J. S. Mehta, Y. M. Por, H. Cajun-Uy, A. Parasarthy, R. W. Beuerman; Comparison of Posterior Stromal Bed Dissection: Microkeraome vs. Femtosecond Laser. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1149.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) requires posterior lamellar donor preparation with use of a microkeratome-artificial chamber device. We developed a procedure to prepare the lamellar donor tissue, using the femtosecond laser. This study evaluates donor surface bed morphology following formation by femtosecond laser compared to microkeratome.

Methods: : Femtosecond laser algorithms utilizing the FEMTEC laser were developed to perform a 7.5mm diameter posterior lamellar dissection at 150 microns from Descemet’s membrane, with a peripheral rim cut enabling complete detachment of the posterior lamella. 40 human eye bank corneas were used; 10 received single lamellar ablation pass, 10 a double pass and 10 a triple pass, at the same optimized laser parameters. 10 corneas were dissected using standard microkeratome. Subjective clinical grading; ease of rim separation, posterior lamellar separation was performed by a single observer. Tissues were fixed and processed for SEM (JEOL JSM-5610LV) and Atomic force microscopy using a standard protocol. Masked independant observers graded the SEM images of stromal bed of the donor disc from 1(poor) to 4(excellent) for surface smoothness. RMS values were calculated from AFM.

Results: : Single pass ablations resulted in poor donor separation in contrast to double and triple pass ablations . Triple pass ablations were marginally superior to double in the ease of separation. Mean score of SEM for the stromal bed of the donor disc was 4 for double/triple pass and 2.25 for single pass (p=0.046) and 2.4 for Microkeratome cut (p<0.05 v single pass, p=0.02 v double/triple pass ablation). RMS values from AFM collobarated the SEM findings in that double/triple pass lamellar bed morphology was superior to that of a single pass and micokeratome beds.

Conclusions: : Femtosecond lasers can be used to prepare the donor corneal lamellae for DSEK. Double and triple pass lamellar ablations provide good bed surface quality and a significant improvement on current microkeratome dissection. Smoother lamellae dissection may improve interface quality between graft and host and hence visual results.

Keywords: cornea: clinical science • cornea: stroma and keratocytes • transplantation 
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