Descemet-Stripping Automated Endothelial Keratoplasty Grafts Prepared from Endothelial Side Using a 500 kHz Femtosecond Laser: Six-Month Outcomes Jesper.

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

ProblemDSAEK 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 graftsan increase in graft thickness towards the periphery in every graft Donor cornea with epithelial side upApplanated cornea during cuttingResulting DSAEK graft of non-uniform thickness

New approachIf 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 upCutting using FS-laser with concave applicatorResulting DSAEK graft of uniform thicknessConcave applicator of the Visumax femtosecond laser

Graft PreparationZeiss-Meditec Visumax 500 kHz FS laser7.5 mm diameter 130 mm thickness#1 FS-laser cutting of DSAEK graft#2 Breaking remaining tissue bridges

Patients & Surgery10 patients with Fuchs endothelial dystrophyAge range: 54 to 78 years of age5 patients had also phaco + PCIOLStandard DSAEK with Busin glide + forceps

#3 DSAEK graft in Busin glide

Results First weekRebubbling 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

Results Visual Acuity (4-6 months)(Decimal units)Average: 0.30Range: 0.16 to 0.50Note shadows in red reflex due to interface haze 3 months after implantation of a DSAEK graft prepared from endothelial side

Corneal Thickness (4-6 months)Average: 0.58 mmRange: 0.51 to 0.63 mmDSAEK graft prepared with Moria ALK keratome (for comparison) (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

Endothelial Cell Count (4-6 months)

Average: 1.570 /mm2

Range:1.400 to 2.000 /mm2

Scanning Electron MicroscopyFS-LaserMoria ALK Note laser spots in FS-laser prepared graft

ConclusionsDSAEK grafts can be prepared from endothelial side using a femtosecond laser10 of 10 grafts clear after 4-6 monthsSatisfying endothelial cell count Poor visual acuity due to scatter in interface from laser spotsFS-Laser settings need to be fine-tuned Acknowledgement: Jacques Chevallier, Dept. of Physics and Astronomy, Univ. of Aarhus for SEM imaging