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• W2021134570 abstract "Editor, We would like to present a new technique of preparation of donor for endothelial keratoplasty (EK), the femtosecond and excimer lasers-assisted endothelial keratoplasty (FELEK). The challenge today is to find a technique of EK reproducible, automatized, giving the smoothest stromal interface of donor to obtain the best visual post-operative recovery (Price & Price 2006). We used scanning electron microscopy (SEM) to compare the smoothness and quality of the endothelial graft interface prepared by four different techniques of lamellar cut, namely mechanical microkeratotomy (Fig. 1A), a single femtosecond laser lamellar cut (Fig. 1B), a double femtosecond laser lamellar cut (Fig. 1C) and combined femtosecond laser 400-μm deep lamellar cut with 30-μm deep excimer laser surface photoablation (Fig. 1D). SEM analysis of the four groups showed decreased smoothness of the stromal interface from group femtosecond combined with excimer lasers to microkeratome, double and single femtosecond laser cut. We obtained the best section quality with the group combining first a femtosecond laser lamellar cut and then a stromal excimer photoablation to smooth the collagen irregularities caused by the femtosecond laser and the lenticule removal. Scanning electron microscopy (SEM) images of the stromal bed (×100) of the donor cornea cut with the mechanical microkeratome (A), single femtosecond laser lamellar dissection (B), double femtosecond laser lamellar dissection (C) and the combination of femtosecond laser lamellar dissection with excimer laser surface photoablation (D). The smoothest stromal interface was observed on SEM with the combined use of femtosecond laser dissection and excimer photoablation followed by mechanical microkeratotomy, double femtosecond laser lamellar cut and single femtosecond laser lamellar dissection. This last technique was then used to prepare the donor corneas for EK on three patients suffering from pseudophakic bullous keratoplasty. First, a single lamellar cut was performed with the Intralase® FS150 femtosecond laser with a lamellar depth of 400 μm. After manual removal of the corneal flap, the donor cornea was transferred under an excimer laser, the Wavelight Allegretto platform (Alcon Laboratories; Fort Worth, TX, USA), for photoablation therapeutic keratectomy procedure performed with a photoablation depth of 30 μm. After an 8.0-mm-diameter ‘descemetorhexis’ was created and was removed from the eye, the endothelial graft was loaded in the Endosaver© (Ocular Systems, Inc., Winston-Salem, NC, USA) injector, folded in it and then inserted through a 4.0-mm incision. The donor lenticule was positioned using the BSS and Rycroft canula. Finally, an air bubble was injected under the endothelial graft to affix the donor tissue onto the recipient posterior stroma. Clinical examination found all corneas cleared after 6 months, and we did not note any complications or graft detachment, so no rebubbling was necessary. At 6 months, best corrected visual acuity increased to 20/40 for one patient but was still low (<20/200) for two patients including one aphakic patient and one with macular oedema. The new technique described in the current letter, FELEK can be an alternative to the Descemet membrane endothelial keratoplasty (DMEK) procedure as DMEK is a difficult manual technique and has a long learning curve (Dapena et al. 2011; Guerra et al. 2011). The FELEK will result in a faster learning curve thanks to the use of lasers, which automates the procedure and makes it reproducible. Use of femtosecond laser to prepare donor cornea offers this safety, accuracy and comfort compared with microkeratome for Descemet-stripping automated endothelial keratoplasty, as in Laser-Assisted In-Situ Keratomileusis for refractive surgery some years ago, while excimer photoablation yields a regular and good-quality interface (better than femtosecond laser only and microkeratome). Indeed, low visual results in femtosecond laser-assisted Descemet-stripping endothelial keratoplasty (FLEK) compared with microkeratome are probably due to a more irregular interface with the endothelial graft (Jones et al. 2008; Mootha et al. 2011). Combining the two lasers provided both precision for the dissection depth of the femtosecond laser and interface quality after excimer laser ablation. To our knowledge, the use of excimer laser to prepare the endothelial graft has never been published. After these preliminary results, a larger cohort of patients operated with this technique might confirm better visual outcomes so that the endothelial outcomes can be studied more closely." @default.
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• W2021134570 date "2013-04-23" @default.
• W2021134570 modified "2023-09-30" @default.
• W2021134570 title "A new technique of endothelial graft: the femtosecond and excimer lasers-assisted endothelial keratoplasty (FELEK)" @default.
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• W2021134570 doi "https://doi.org/10.1111/aos.12155" @default.
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