Posters

Femtosecond laser-assisted descemetorhexis in Descemet's membrane endothelial keratoplasty (DMEK) surgical procedure

Poster Details

First Author: M.Garcia-Mendieta SPAIN

Co Author(s):    N. Barnils   R. Rodriguez   M. Lopez-Lopez   N. Planas   T. Martí   J. Martineau     

Abstract Details

Purpose:

Descemetorhexis is the key step during surgery in posterior lamellar keratoplasty, and it must have a precise diameter and cut, since its quality is transcendental for surgical success. After the femtosecond laser use extension, its use has indeed been proposed in performing descemetorrexis in the recipient cornea. In this way, it is possible to increase the precision and surgical accuracy, maximizing the probabilities of final transparency of the graft and minimizing the detachment index of Descemet membrane.

Setting:

Cornea Unit - Bellvitge Hospital (University of Barcelona), L'Hospitalet, Barcelona, Spain.

Methods:

A new approach for a quality descematorhexis by using femtosecond laser-assisted (Victus®) was performed in 4 cases. Firstly, pupillary center was positioned. A cut diameter between 8 and 9.5mm was programmed, depending on the white-to-white measurement. The laser makes a circular cut starting from the endothelial side of the cornea and from a depth corresponding to 120% of the pachimetry. Treatment is carried out whilst it can be visualized in real-time anterior-segment optical coherence tomography (AS-OCT). Energy was set in 1.3mJ, by increasing it according to the transparency of the cornea, if required.

Results:

In terms of automated procedure, a descemetorhexis of precise diameter is obtained, with clear and not scalloped edges. Likewise, a reduction of areas devoid of endothelial cells seem to occur, although a paradoxical elevation of endotelial overlap seems to be more frequent in the femtosecond laser procedure. This overlap seems to be directly related to the diameter of the descematorhexis, though.

Conclusions:

The higher precision of femtosecond laser-assisted descemetorhexis compared with manual technique leads to a sustantial improvement in DMEK surgery, owing to the lack of bridges or scalloped edges that eases Descemet's membrane attachment. The factor that seems to be decisive is to perform a correct cut of the entire thickness of the Descemet membrane as well as to minimize the thickness of the deep stroma removed. Notwithstanding, few publications have been released about it, so larger series as well as more data is required.

Financial Disclosure:

... is employed by a for-profit company with an interest in the subject of the presentation