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L. Menabuoni, I. Lenzetti, T. Rutili, F. Rossi, R. Pini, S. H. Yoo, J.-M. Parel; Combining Femtosecond and Diode Lasers to Improve Endothelial Keratoplasty Outcome. A Preliminary Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4711.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the feasibility of a new laser-assisted technique in deep lamellar endothelial keratoplasty (DLEK), using the IntraLase® femtosecond laser to prepare the donor endothelial flap and spot welding it in situ with a diode laser.
Based on our previous clinical experiences in 810nm diode laser-induced welding of corneal tissue in penetrating and lamellar keratoplasty*, we applied this novel laser technique to DLEK in combination with the IntraLase® femtosecond laser. In 3 volunteers suffering from endothelial pathologies, the IntraLase® was used for the preparation of a 100 micron thick, 8.5 mm diameter donor corneal endothelium flap. The flap stromal side was then stained with a solution of Indocyanine Green (ICG) used as a photoenhancing chromophore. After a circular-8 mm diameter stripping of the recipient Descemet membrane and endothelium, the donor flap was positioned by an air bubble and stabilized by means of 4 laser welding spots of 200 micron diameter performed peripherally with a fiberoptic contact probe introduced in the anterior chamber.
Diode laser pulses of 160 mJ and 0.2 s provided effective spot welds between donor endothelial flap and recipient stromal surfaces. Postoperative day 1, 3 and 30 exams showed excellent donor flap adhesion and a complete re-absorption of the ICG after 3 days.
IntraLase® sculpturing of the donor cornea provided good endothelial flaps of preset and constant thickness. Diode laser-induced spot welding showed a unique potential to permanently secure the donor flap in place avoiding postoperative displacement that may occur when using the air bubble alone in the anterior chamber. Further studies to obtain statistically significant data are underway. *L. Menabuoni, R. Pini, M. Fantozzi, M. Susini, I. Lenzetti, and S.H. Yoo, "All-Laser" Sutureless Lamellar Keratoplasty (ALSL-LK): A First Case Report. Invest. Ophthalmol. Vis. Sci. 2006 47: E-Abstract 2356.
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