Long term observation of low-power diode laser welding after penetrating keratoplasty in human patients

Abstract

Low power diode laser welding is a recently developed technique used as a support tool for conventional suturing in ophthalmic surgery. The main application is in penetrating keratoplasty: in the last four years (2005-2009), clinical trials were performed at the Ophthalmic Department of Prato (Italy). In penetrating keratoplasty, diode laser welding is used to assure the transplanted corneal button in its final position. The donor tissue is positioned in the recipient eye and 8-16 single stitches are apposed. The surgical wound is then stained with a saturated (10% w/w) sterile water solution of Indocyanine Green (ICG), it is washed with sterile water and then a diode laser (810 nm, 13 W/cm²) is used to induce the sealing of the wound. The laser light induces a thermal effect, localized in the stained tissue. In vivo and ex vivo studies in animal models evidenced that welding induces a modification of the corneal collagen architecture through the wound walls, thus enabling a short healing time and a good restoration of the tissue. In this study on human subjects, we confirmed the results evidenced in animal models, by morphological observations. In two cases out of 60, transplant rejection was observed. It was thus possible to study the efficacy of laser welding in the closure of the wound one year after implant. Direct morphological observation evidenced good strengthens of the welded tissue. Histological analysis pointed out a good restoration of the regular collagen architecture at the external perimeter of the corneal button, where laser welding was performed, showing the occurrence of a correct and effective wound healing process.