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Abstract
Abstract
Nonmechanical Posterior Lamellar Keratoplasty Using a Femtosecond Laser (femto-PLAK) for Corneal Endothelial Decompensation
Seitz B., Langenbucher A., Hofmann-Rummelt C., Schlötzer-Schrehardt U., Naumann G. O. H.
Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
Purpose: In corneal endothelial diseases, such as Fuchs' dystrophy, G. Melles and M. Terry introduced the technique of posterior lamellar keratoplasty (endokeratoplasty) to selectively exchange endothelium, Descemet's membrane and as little adjacent stroma as possible. Since manual lamellar dissection is still technically very demanding the purpose of this study was to assess the potential of a short pulsed laser to cut a posterior graft and bed in a controlled automated manner.
Method: In this laboratory study 18 freshly enucleated porcine eyes and 10 human donor corneas not suitable for corneal transplantation were treated. Using the laser FEMTEC (20/10 PERFECT VISION, Heidelberg, Germany) we performed posterior lamellar dissections in the whole globe (wave length ~1 microm, pulse energy <10 microJ, spot size <10 microm, repetition rate 12.5 kHz) starting from the anterior chamber with the axial cylinder cut and finalizing with the lamellar bed. Following the laser action complete flaps (6 to 7 mm diameter) were either removed manually or left in situ. Specimens were fixed in 10% buffered formaldehyde solution and processed for PAS/HE light microscopy, transmission (TEM) and scanning (SEM) electron microscopy. Main outcome measures included (1) feasibility of the flap creat