"Ultrathin" DSAEK tissue prepared with a low-pulse energy, high-frequency femtosecond laser

Cornea. 2013 Jan;32(1):81-6. doi: 10.1097/ICO.0b013e31825c72dc.


Purpose: To evaluate the endothelial cell survival and stromal bed quality when creating deep stromal cuts with a low-pulse energy, high-frequency femtosecond laser to produce "ultrathin" tissue for Descemet stripping automated endothelial keratoplasty.

Methods: Seventeen corneas were used for this study. Five corneas were cut with the laser at a depth of 420 to 500 μm to produce a tissue thickness of approximately ≤70 μm. Five corneas served as an uncut comparison group. Vital dye staining and computer digitized planimetry analysis were performed on these corneas. The 7 remaining corneas were cut for scanning electron microscopy evaluation.

Results: The mean central posterior stromal thickness of cut corneas was 60.6 μm (range, 43-72 μm). Endothelial cell damage in cut and comparison corneas was 3.92% ± 2.22% (range, 1.71%-6.51%) and 4.15% ± 2.64% (range, 1.21%-7.01%), respectively (P = 0.887). Low-magnification (×12) scanning electron microscopy revealed a somewhat irregular-appearing surface with concentric rings peripherally. Qualitative grading of higher magnification (×50) central images resulted in an average score of 2.56 (between smooth and rough).

Conclusions: Ultrathin tissue for Descemet stripping automated endothelial keratoplasty can be safely prepared with minimal endothelial cell damage using a low-pulse energy, high-frequency femtosecond laser; however, the resulting stromal surface quality may not be optimal with this technique.

MeSH terms

  • Cell Count
  • Cell Survival
  • Cornea / surgery*
  • Corneal Pachymetry
  • Corneal Stroma / ultrastructure
  • Descemet Stripping Endothelial Keratoplasty*
  • Endothelium, Corneal / ultrastructure*
  • Humans
  • Lasers, Excimer / therapeutic use*
  • Low-Level Light Therapy / methods*
  • Microscopy, Electron, Scanning