Excimer Laser Smoothing of Endothelial Keratoplasty Grafts
- 1 April 2012
- journal article
- basic investigation
- Published by Ovid Technologies (Wolters Kluwer Health) in Cornea
- Vol. 31 (4), 431-436
- https://doi.org/10.1097/ico.0b013e31822444a7
Abstract
Purpose To use excimer laser smoothing passes to reshape Descemet-stripping automated endothelial keratoplasty (DSAEK) endothelial grafts and to evaluate the effect on the donor endothelium. Methods The stromal surface of microkeratome-cut DSAEK grafts was smoothed using excimer laser smoothing passes with masking fluid. Excimer laser hyperopic ablation was used to improve the uniformity of graft thickness within the optical zone. Fourier-domain optical coherence tomography was used to measure endothelial graft pachymetry, plan ablations, and evaluate donor contour. Vital dye staining was performed to assess endothelial cell damage. Scanning electron microscopy images of stromal surfaces were graded on a 5-point scale by masked observers to evaluate surface roughness. Results Four grafts underwent excimer laser smoothing. Vital dye staining showed no endothelial damage. Microkeratome-cut surfaces treated with laser smoothing (mean grade = 2.04) were smoother than nonsmoothed microkeratome-cut surfaces (mean grade = 4.07; P < 0.01), surfaces that underwent dry laser ablation (mean grade = 3.63; P < 0.01) and manually dissected interfaces (mean grade = 4.75; P < 0.0001). No difference was observed between stromal beds created by peeling Descemet membrane (mean grade = 1.64) compared with surfaces produced by microkeratome cutting followed by laser smoothing (mean grade = 2.04; P = 0.14). One graft underwent combined excimer smoothing and peripheral hyperopic ablation. The center–periphery thickness difference was 15 μm before ablation and 4 μm afterward. Conclusions Laser smoothing passes can be used to improve the contour and smoothness of DSAEK grafts without damaging donor endothelial cells. Clinical trials are needed to determine whether reshaping donors using excimer laser can deliver improved visual outcomes after DSAEK.Keywords
This publication has 20 references indexed in Scilit:
- Secondary Graft Failure and Repeat Endothelial Keratoplasty after Descemet's Stripping Automated Endothelial KeratoplastyOphthalmology, 2011
- Descemet's Membrane Endothelial KeratoplastyOphthalmology, 2009
- Stability of hyperopic refractive shift following Descemet-stripping automated endothelial keratoplastyJournal of Cataract & Refractive Surgery, 2009
- Retrospective Contralateral Study Comparing Descemet Stripping Automated Endothelial Keratoplasty With Penetrating KeratoplastyCornea, 2009
- Excimer laser–assisted lamellar keratoplasty for the surgical treatment of keratoconusJournal of Cataract & Refractive Surgery, 2009
- An Easy and Inexpensive Method for Quantitative Analysis of Endothelial Damage by Using Vital Dye Staining and Adobe Photoshop SoftwareCornea, 2008
- Descemet-Stripping Automated Endothelial KeratoplastyCornea, 2008
- Corneal profile analysis after Descemet stripping endothelial keratoplasty and its relationship to postoperative hyperopic shiftJournal of Cataract & Refractive Surgery, 2008
- Descemet’s Stripping with Endothelial Keratoplasty: Comparative Outcomes with Microkeratome-Dissected and Manually Dissected Donor TissueOphthalmology, 2006
- Histology of Dislocations in Endothelial Keratoplasty (DSEK and DLEK)Cornea, 2006