Customized Transplant Geometry Using the Excimer-Laser. Experimental Study in a Rabbit Model and First Clinical Application
Eye-Department, Otto-von-Guericke-University, Magdeburg
Purpose: To develop a technique for congruent trephination of donor and recipient cornea in free form using a 193 nm Excimer laser, to evaluate its clinical applicability in an animal model, and to assess the feasibility of the procedure in human keratoplasty.
Method: In 12 NZW-rabbits homologous penetrating keratoplasty was performed. In six animals, trephination of donor buttons and recipient beds was achieved by conventional mechanical trephination, and in six animals by Excimer laser trephination with a guided laser beam in a non-circular geometry. The surgical procedure and the clinical course until six months postoperatively were evaluated. At 3 and 6 weeks and at 6 months after surgery corneal specimen of sacrificed animals were processed for histology for evaluation of corneal wound healing.
The experimental study was followed by the first clinical application of the techniquein two patients with perforated peripheral corneal ulcers associated with rheumatic disease.
Results: The surgical procedure of full-thickness Excimer laser trephination could be performed reproducibly in the animal model both for dissection of donor buttons and for preparation of the recipient beds. Keratoplasty was performed with kidney-shaped transplants after trephination in free form with the guided laser beam. Postoperative clinical follow-up did not show any differences between the two
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