Nonmechanical posterior lamellar keratoplasty using the femtosecond laser (femto-plak) for corneal endothelial decompensation.

Abstract

To assess the potential of a short pulsed laser to cut a posterior graft and bed for posterior lamellar keratoplasty (PLAK). Experimental study. Using the laser FEMTEC (20/10 Perfect Vision, Heidelberg, Germany), posterior lamellar dissections (wave length approximately 1 microm, pulse energy < 10 microJ, spot size <10 microm, repetition rate 12.5 kHz, 6-mm-7 mm diameter, 31 s and 90 s) were performed in 18 freshly enucleated porcine eyes and 10 human donor corneas starting from the anterior chamber and ending with the lamellar bed. Before removal, 50 microm to 500 microm-thick flaps were delineated by partly confluent gas bubbles (maximum 2-mm long) with minute tissue bridges (typically 5- to 10 microm) in between. Scanning electron microscopy displayed smooth cut surfaces and rectangular corners with minor remaining tissue bridges (approximately 5 microm). By transmission electron microscopy, the cut edges were lined by a delicate, electron-dense layer (5 nm-10 nm in width) and essentially normal adjacent collagen fibers. Femtosecond laser technology seems to offer a promising approach to minimally invasive posterior lamellar keratoplasty (femto-PLAK) through small tunnel incisions in corneal endothelial diseases.