Deep Stromal Dissection for Endothelial Keratoplasty Obtained with a Femtosecond Laser and a Microkeratome with Different Head Advancement Speeds. A Scanning Electron Microscopy StudyP. Scaroni, R. Leaci, D. Dallatana, A. Neri, L. Fontana°, C. Macaluso.Ophthalmology, University of Parma, Parma, Italy.°Eye Bank Institute of Emilia Romagna, Bologna,Italy. FINANCIAL DISCLOSURE FOR ALL AUTHORS :NONE
To explore the surface quality of deep stromal dissections in bank eyes obtained with either a femtosecond laser or a microkeratome used with three different head advancement speeds.
12 sclerocorneal donor buttons, not suitable for human transplantation, mounted on an artificial chamber.
1000 KHz Femtosecond laser (Femto LDV, Ziemer, Switzerland) at 400µm depth :
MicrokeratomeCarriazo Barraquer, Moria, France. Mounting a 300µm head.
Different speeds to perform the dissection:
The stromal surface of the endothelial buttons of the FEMTOLASER group showed a generally excellent smoothness, but with some small rough areas (red arrow).
Best areas obtained with the femtolaser: the surface is regular and the stromal fibers have been cut and not ripped off
In the images above it’is clear that many stromal fibers have been torn and not cut and the quality of the surfaces is poor
Differently from the FEMTOLASER group, all microkeratome dissected endothelial buttons failed to show significant variations in smoothness across the cut surface.
While the surface of the MEDIUM and of the SLOW groups were regular, the FAST group showed a rougher surface.
The smoothness obtained in the best areas of the FEMTOLASER group was unmatched by the surfaces obtained in any of the microkeratome groups.
The quality of the surfaces obtained with microkeratome and femtolaser can be compared. And both can be compared with the smoothness of the receiving bed for endothelial transplantation, i.e. the stroma after Descemet stripping
Stroma after Descemet stripping
MICROKERATOMEdissection of endothelial corneal buttons resulted in consistent regular cut surfaces, but it is advisable to complete the head movement rather slowly, in at least 8-10 seconds.
FEMTOSECOND lasertechnology has the potential for generating endothelial corneal buttons with extremely smooth surfaces, even better than those that can be obtained with a microkeratome. Nevertheless, the deep stromal location of the cut may limit the overall regularity of the dissected surface. It is conceivable that the suboptimal optical properties of rejected eye bank tissues could have heavily contributed to this problem, limiting proper laser focusing in the deep stroma.