Femtosecond laser and microkeratome preparation of ultrathin (UT) DSAEK Grafts, the six months clinical results

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AbstractPurpose To evaluate the use of a femtosecond laser and a mechanical microkeratome to prepare ultrathin posterior corneal disks for Descemet stripping automated endothelial keratoplasty (DSAEK) and to assess associated visual results, disk thickness and endothelial cell loss.Methods This clinical study involved ultrathin DSAEK tissue preparation used in 28 patients with endothelial dysfunction. The first cut was performed with an Intralase FS60 laser and the second cut with a Moria CBm 300‐ microkeratome. The thickness of the first cut was modified for each cornea to obtain a final graft thickness of 120 µm. Post‐op central graft thickness was performed with corneal laser tomography (Spectralis). Central endothelial cell density (ECD) was calculated before, 3 and 6 months after surgery.Results Final graft thickness was 92.9+28.5 µm, 83.1+23.6 µm, 77.2+16.9 µm and 74.3+27.5 µm at one week, one three and six months post‐op, respectively. No loss of corneas due to irregular cuts or perforation during preparation. The mean BSCVA was 0.4, 0.5, 0.7 and 0.7(0.39, 0.35, 0.16 and 0.17 LogMAR) after one week, one, three and six months post‐op, respectively. A 26.3% and 31.2% endothelial cell loss was observed after 3 and 6 months of the surgery, respectively. Significant positive correlation between BCVA (logMAR) and central graft thickness at 1 and 3 months was observed (r=0.76,p=0.01; r=0.73,p=0.01) as well as between BCVA (logMAR) at 3 months and preoperative central graft thickness (r=0.82,p=0.007; Spearman correlation). Patients without bullous keratopathy achieved better visual outcome at 3 months (p=0.04, Mann‐Whitney test).Conclusion Femtosecond laser and microkeratome can be used sequentially to prepare custom ultrathin DSAEK grafts with no loss of corneas. This procedure minimizes the variability inherent to microkeratomes and allows very quick recovery of visual acuity after posterior lamellar keratoplasty.