Abstract
Corneal grafts for Descemet’s Stripping Automated Endothelial Keratoplasty are commonly prepared using mechanical microkeratomes. However, the cuts produced in such way render corneal lenticules that are thinner centrally than peripherally, thus inducing a hyperopic shift. Here we describe a novel device for preparing donor corneal grafts, in which a single low-energy femtosecond laser system is used as both a light source for optical coherence tomography and for cutting the graft illuminating from the endothelial side. The same laser is first utilized to obtain three-dimensional optical coherence tomography images of the donor tissue for guiding the dissection and obtaining grafts of uniform thickness with no applanation or contact. This device allows an optimal procedure for preparing consistently thin posterior grafts for transplantation.
Highlights
The newer techniques that have been developed for corneal transplantation are limited to grafting only the diseased layers, while leaving the host’s healthy corneal layers untouched
The functional outcome of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is partly limited by suboptimal optical results, which are directly related to the shape of the graft
Preparing such donor corneal grafts, in which a low-energy femtosecond laser (FSL) system is used as both a light source for optical coherence tomography (OCT) [23,24,25] and for cutting the graft illuminating from the endothelial side
Summary
The newer techniques that have been developed for corneal transplantation are limited to grafting only the diseased layers, while leaving the host’s healthy corneal layers untouched. The host cornea is prepared using a standardized microkeratome to cut the anterior cornea and retain the posterior stroma with Descemet’s Membrane and the Endothelium. Grafts routinely prepared with mechanical microkeratomes are typically thinner centrally than peripherally, yielding a hyperopic shift (negative lens effect) that necessitates additional optical correction in the spectacles of the operated eye. In order to obtain more uniform and ultrathin DSAEK lenticules, double-pass microkeratome cuts have been proposed, where the second cut starts from the end of the first cut [13]. This technique, is still overshadowed by a non-negligible rate of microkeratome-related complications (7.2 %) occurring during donor tissue preparation [14]
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