Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology,

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

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

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

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

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

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

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

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

Endothelial Cell Count (4-6 months)

• Average: • 1.570 /mm2

• Range:• 1.400 to 2.000 /mm2

Scanning Electron Microscopy

FS-LaserFS-Laser Moria ALK Moria ALK

Note laser spots in FS-laser prepared graft

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