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Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology,

Descemet-Stripping Automated Endothelial Keratoplasty Grafts Prepared from Endothelial Side Using a 500 kHz Femtosecond Laser: Six-Month Outcomes. Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology, Aarhus University Hospital, Denmark.

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Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology,

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  1. Descemet-Stripping Automated Endothelial Keratoplasty Grafts Prepared from Endothelial Side Using a 500 kHz Femtosecond Laser: Six-Month Outcomes Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology, Aarhus University Hospital, Denmark The authors have no financial interest in the subject matter of this poster

  2. Problem • DSAEK grafts are usually cut by a micro-keratome or a femtosecond laser after the epithelial side of the donor cornea has been applanated • This approach result in • variable central graft thickness in different grafts • an increase in graft thickness towards the periphery in every graft Donor cornea with epithelial side up Applanated cornea during cutting Resulting DSAEK graft of non-uniform thickness

  3. New approach • If DSAEK grafts can be prepared from the endothelial side by a femtosecond laser, reproducible, thin grafts of even thickness can be produced Donor cornea with endothelial side up Cutting using FS-laser with concave applicator Resulting DSAEK graft of uniform thickness Concave applicator of the Visumax femtosecond laser

  4. Graft Preparation • Zeiss-Meditec Visumax 500 kHz FS laser • 7.5 mm diameter • 130 mm thickness #2 Breaking remaining tissue bridges #1 FS-laser cutting of DSAEK graft

  5. Patients & Surgery • 10 patients with Fuchs endothelial dystrophy • Age range: 54 to 78 years of age • 5 patients had also phaco + PCIOL • Standard DSAEK with Busin glide + forceps #3 DSAEK graft in Busin glide

  6. Results – First week • Rebubbling necessary in 5 of 10 cases (normally only in 1 of 10 cases) • All grafts were attached and clearing up after one week 3 months after implantation of a DSAEK graft prepared from endothelial side

  7. Results – Visual Acuity (4-6 months) • (Decimal units) • Average: 0.30 • Range: 0.16 to 0.50 3 months after implantation of a DSAEK graft prepared from endothelial side Note shadows in red reflex due to interface haze

  8. Corneal Thickness (4-6 months) • Average: 0.58 mm • Range: 0.51 to 0.63 mm Note uniform thickness, but interface haze of FS-laser prepared graft DSAEK graft prepared with Visumax FS-laser from endothelial side (Pentacam HR) DSAEK graft prepared with Moria ALK keratome (for comparison) (Pentacam HR)

  9. Endothelial Cell Count (4-6 months) • Average: • 1.570 /mm2 • Range: • 1.400 to 2.000 /mm2

  10. Scanning Electron Microscopy FS-Laser Moria ALK Note laser spots in FS-laser prepared graft

  11. Conclusions • DSAEK grafts can be prepared from endothelial side using a femtosecond laser • 10 of 10 grafts clear after 4-6 months • Satisfying endothelial cell count • Poor visual acuity due to scatter in interface from laser spots • FS-Laser settings need to be fine-tuned Acknowledgement: Jacques Chevallier, Dept. of Physics and Astronomy, Univ. of Aarhus for SEM imaging

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