Femtosecond laser and microkeratome preparation of ultrathin (UT) DSAEK grafts

Abstract

AbstractAn important limitation of DSAEK is that some eyes do not achieve good visual acuity despite a clear cornea and minimal residual astigmatism. The thickness of the stromal lamella may influence the final visual acuity and better results may be achieved with thinner grafts. We describe a new technique that combines a femtosecond laser with a microkeratome to obtain consistently thin grafts, with no loss of corneas. This clinical study involves 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‐µm 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). Associated visual results, disk thickness and endothelial cell loss before and after surgery were evaluated. Final graft thickness was 88.3+27.6 µm, 77.2+26.6 µm and 74.3+27.5 µm at one week, one and three months post‐op, respectively. No loss of corneas due to irregular cuts or perforation during preparation. The mean BSCVA was 0.41, 0.52, and 0.72(0.39, 0.28 and 0.14 LogMAR) after one week, one and three months post‐op, respectively. Precut and post‐op (3 months) ECDs averaged 2553 cells/mm2 and 1882 cells/mm2, respectively, representing 26.3% endothelial cell loss after 3 months of the surgery. 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.