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Clear cornea femto DALK: a novel approach for deep anterior lamellar keratoplasty (DALK) with femtosecond laser-assistance: first results

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First Author: G.Gerten GERMANY

Co Author(s):    P. Thiee   U. Oberheide                 

Abstract Details

Purpose:

We report the results of the first cohort of Patients treated with our novel technique for femtosecond laser assisted (fs) DALK surgery, Clear Cornea Femto DALK. Currently, even if femtosecond lasers are used to cut surface-parallel layers (“deep flaps”), the technique of manually denuding Descemet’s Membrane basically stays the same as in manual techniques. In Clear Cornea (CC) Femto DALK, a fs Laser is used to do a complete posterior/anterior trephination of the stroma, from a liquid chamber to the epithelium, under optical coherence tomography control.

Setting:

Augenklinik am Neumarkt, Private Ophthalmology Clinic , Technische Hochschule Köln, Department of Applied Optics, Laserforum Köln e.V., Private Research Institute; all located in Cologne, Germany

Methods:

Femto Bubble DALK technique was applied in 12 eyes of 12 patients with advanced keratokonus or deep stromal scars. Firstly, a tunnel through the corneal stroma was created down to Descemet´s Membrane either mechanically or by fs-Laser. A specially developed cannula was used to inject liquid for separating Descemet’s membrane without compromising stromal’s transparency. Then a femtosecond laser trephined a stromal button in posterior–anterior mode under OCT-guidance. A stromal transplant was sutured onto the Patient´s Descemet. After 6 month a ophthalmological examination was performed including contact lens VA, Scheimpflug measurement, AS-OCT and endothelial cell count.

Results:

The Femto Bubble Technique was successful in 11 out of 12 cases, of which 10 have six months’ results available so far. The femtosecond laser (Alcon LenSx) trephined the central stroma from the liquid separation bubble up to the epithelium with a diameter between 7.4 and 8 mm. Manual removal of tissue remnants on Descemet´s was not necessary. All patients kept their own endothelium with average cell loss < 15%. UCVA increased on average by ≥5 lines up to 0.6 logMAR in all cases. Mean contact lens VA increased from pre OP 0.9 logMAR to 0.2 logMAR post OP.

Conclusions:

The combination of Clear Cornea Descemet’s dissection and OCT-guided femtosecond laser trephination seems to open a new option for DALK surgery. A complete baring of Descemet’s membrane while decreasing perforation risk was achieved.

Financial Disclosure:

... gains financially from product or procedure presented, ... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented