Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology,
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Transcript of Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology,
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Descemet-Stripping Automated Endothelial Keratoplasty Grafts Prepared from Endothelial Side Using a 500 kHz
Femtosecond Laser: Six-Month Outcomes
Jesper Hjortdal, Anders Ivarsen, Kim NielsenDepartment of Ophthalmology,
Aarhus University Hospital, Denmark
The authors have no financial interest in the subject matter of this poster
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Problem• DSAEK grafts are usually
cut by a micro-keratome or a femtosecond laser after the epithelial side of the donor cornea has been applanated
• This approach result in – variable central graft
thickness in different grafts– an increase in graft
thickness towards the periphery in every graft
Donor cornea with epithelial side up
Applanated cornea during cutting
Resulting DSAEK graft of non-uniform thickness
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New approach
• If DSAEK grafts can be prepared from the endothelial side by a femtosecond laser, reproducible, thin grafts of even thickness can be produced
Donor cornea with endothelial side up
Cutting using FS-laser with concave applicator
Resulting DSAEK graft of uniform thickness
Concave applicator of the Visumax femtosecond laserConcave applicator of the
Visumax femtosecond laser
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Graft Preparation
• Zeiss-Meditec Visumax 500 kHz FS laser
• 7.5 mm diameter • 130 m thickness
#1 FS-laser cutting of DSAEK graft
#2 Breaking remaining tissue bridges
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Patients & Surgery
• 10 patients with Fuchs endothelial dystrophy
• Age range: 54 to 78 years of age
• 5 patients had also phaco + PCIOL
• Standard DSAEK with Busin glide + forceps #3 DSAEK graft in Busin glide
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Results – First week
• Rebubbling necessary in 5 of 10 cases (normally only in 1 of 10 cases)
• All grafts were attached and clearing up after one week
3 months after implantation of a DSAEK graft
prepared from endothelial side
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Results – Visual Acuity (4-6 months)
• (Decimal units)• Average: 0.30• Range: 0.16 to 0.50
Note shadows in red reflex due to interface haze
3 months after implantation of a DSAEK graft
prepared from endothelial side
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Corneal Thickness (4-6 months)
• Average: 0.58 mm• Range: 0.51 to 0.63 mm
DSAEK graft prepared with Moria ALK keratome (for comparison) (Pentacam HR) DSAEK graft prepared with Moria ALK keratome (for comparison) (Pentacam HR)
DSAEK graft prepared with Visumax FS-laser from endothelial side (Pentacam HR)DSAEK graft prepared with Visumax FS-laser from endothelial side (Pentacam HR)
Note uniform thickness, but interface haze of FS-laser prepared graft
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Endothelial Cell Count (4-6 months)
• Average: • 1.570 /mm2
• Range:• 1.400 to 2.000 /mm2
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Scanning Electron Microscopy
FS-LaserFS-Laser Moria ALK Moria ALK
Note laser spots in FS-laser prepared graft
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Conclusions
• DSAEK grafts can be prepared from endothelial side using a femtosecond laser
• 10 of 10 grafts clear after 4-6 months• Satisfying endothelial cell count • Poor visual acuity due to scatter in interface
from laser spots• FS-Laser settings need to be fine-tuned
Acknowledgement: Jacques Chevallier, Dept. of Physics and Astronomy, Univ. of Aarhus for SEM imaging