Combined Use of a Femtosecond Laser and a Microkeratome in Obtaining Thin Grafts for Descemet Stripping Automated Endothelial Keratoplasty: An Eye Bank Study

Abstract

Purpose: To evaluate the use of a femtosecond laser combined with a microkeratome in the preparation of posterior corneal disks for Descemet stripping automated endothelial keratoplasty (DSAEK

Nomogram for Single-pass Two-speed Automated Microkeratome Graft Preparation for Ultrathin Descemet Stripping Automated Endothelial Keratoplasty

“…[25] However, most of these studies used the double-pass microkeratome technique,[8, 25,26] which involves signi cant risk for perforation, endothelial cell loss and stromal surface irregularity. Other studies have used a single 350 µm blade head in 10 corneas, [9] a combination of femtosecond [10] or a manual rotation system. [10,26] In our study, we assessed the variable of microkeratome cutting speed, con rming that there was no variation with respect to the fast or slow speed.…”

“…Other studies have used a single 350 µm blade head in 10 corneas, [9] a combination of femtosecond [10] or a manual rotation system. [10,26] In our study, we assessed the variable of microkeratome cutting speed, con rming that there was no variation with respect to the fast or slow speed. This does not occur with other microkeratomes such as the automated Amadeus II, which uses a head advancement speed of 3.0, 2.0 and 1.5 mm/sec and achieves statistically signi cant results with mean graft thicknesses one month postoperatively of 99.33 ± 16.97 µm.…”

“…To date, ultra-thin lamellar grafts have been considered to be those with a central graft thickness between 100 and 130 µm. [3] Multiple techniques have been described to achieve this goal: simple nomograms, [4] double-pass microkeratome cuts, [5,6] stromal thinning by directing sterile air ow, [7] use of polyvinyl alcohol or cellulose sponges [8] or placing the tissue in hyperosmotic tissue medium [9] before tissue preparation, combinations of femtosecond [10] and/or excimer laser [11] and varying arti cial anterior chamber (AAC) pressure. [12] Nevertheless, not all of these techniques reliably produce ultrathin tissue and may result in tissue loss (button hole, decrease of endothelial cells), increase tissue preparation time and add substantial nancial costs.…”

Visual Outcomes and Graft Thickness in Microthin DSAEK—One-Year Results

“…4,5,9 There are a variety of terms used to describe such grafts (thin DSAEK, ultrathin DSAEK), and the widely accepted definition of thin grafts carries a central graft thickness (CGT) of ,100 to 130 mm. 9,11,12 The main rate-limiting step in achieving a thin DSAEK graft is the increased thickness encountered in corneas of deceased donors. 13 Human donor corneas in both organ culture and cryopreservation demonstrate stromal swelling, leading to variably increased thickness of endothelial grafts for a constant thickness of the anterior lamella removed during microkeratome dissection.…”