Femtosec laser assisted endothelial Keratoplasty

Purpose: To evaluate the safety and feasibility of the FS laser for the preparation of posterior lamellar discs and to evaluate the first clinical results of a new technique – Femtosecond Laser Descemet Stripping Endothelial Keratoplasty (FS-DSEK) – for surgical treatment of corneal diseases. Setting: Department of Ophthalmology, Academic Hospital, Maastricht, The Netherlands. Cornea Bank, Amsterdam, The Netherlands. University Medical Center, Groningen, The Netherlands. University Medical Center St. Radboud, Nijmegen, The Netherlands. Methods: A 30kHz FS laser (IntraLase Corp., Irvine, CA) was used to prepare a lamellar cut in the cornea of human donor eyes. After FS laser preparation of a 9.5mm wide lamellar cut at a depth of 400 micron, the corneoscleral button was stored in organ culture medium. The endothelial viability was assessed after preparation of the lamellar cut and after dissection of the donor posterior lamellar disc (PLD) from the anterior cornea. In ten eyes of ten patients with pseudophakic bullous keratopathy the PLDs were used for endothelial keratoplasty. The follow-up ranged from 13 to 20 weeks. Results: The mean±sd endothelial cell loss after FS preparation of the lamellar cut (n=4) was 3.4%±3.5% and after dissection of the posterior lamellar disc (n=5) was 6.5%±3.2%. There was no significant difference in endothelial cell loss between FS and non-FS laser treated corneas after organ culture (p=0.46). All eyes had a clear graft with functioning endothelium. In 4 eyes BCVA was 20/40 to 20/50. In the other 6 eyes BCVA ranged from 20/200 to 20/40 and 5/6 eyes had pre-existing maculopathy. The surgically induced astigmatism was 2.1 D. Longer-term results will be presented to assess graft clarity and visual outcomes in the other eyes. Conclusion: FS laser preparation of posterior lamellar discs is safe and feasible for performing FS-DSEK. We believe that FS-DSEK offers a great potential for facilitating endothelial keratoplasty in a more standardized, automated fashion. Longer-term follow-up will be necessary to assess final corneal graft clarity and visual outcome.