The first experience of DSAEK with extremely thin graft prepared with excimer laser (clinical case)
A.N. PASHTAEV, S.B. IZMAILOVA, S.S. ALIEVA
The S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskoudnikovsky blvd., Moscow, Russian Federation, 127486
Pashtaev A.N. ― Cand. Med. Sc., Junior Researcher of the Department of Transplantation and Opto-Reconstructive Surgery of anterior segment of the eyeball, e-mail: PashtaevMD@gmail.com
Izmailova S.B. ― D. Med. Sc., Head of the Department of Transplantation and Opto-Reconstructive Surgery of anterior segment of the eyeball, е-mail: lana-dok@mail.ru
Alieva S.S. ― doctor-ophthalmologist, e-mail: dr.aliyeva03.11@gmail.ru
2 patients with secondary corneal endothelial dystrophy of the cornea, pseudophakia and Fuchs’s corneal endothelial dystrophy were examined and operated. The first patient underwent E-DSAEK, the second ― with IOL implantation and E-DSAEK. The extremely-thin graft was prepared as follows: the corneal-sclera donor corneal disc stored in Borzenko ― Moroz medium was fixed on the artificial anterior chamber and 1 cut with mechanical mikrokeratome Моria SLK 3 (France) with the head of 300 mkm. Then, using ultrasound pachimetry (Alcon, USA), the thickness of the residual fibers of the donor cornea was determined. Basing on these data, with Microscan 500 («Optosystems», Troitsk), photoablation was performed with a flat beam of FTK type to the necessary depth, with the following parameters: ablation zone diameter 10.9 mm, optical zone diameter 9.0 mm. Then, the transplant with the diameter of 8.0 mm was cut with Моria punch (France). Keratoplasty was performed with standard technique through the temple corneo-sclera tunnel incision with the length of 4.5 mm. After 6 month, corneas of both patients kept transparency. BCVA of patient A. was 0.4, postoperative astigmatism ― 1.5 D, ECD ― 1242 cells/mm2. The endothelial cells loss was 46%. In patient B. BCVA was 0.5, postoperative astigmatism ― 2.75 D, ECD ― 1298 cells/mm2. The endothelial cells loss was 45.9%.
Key words: endothelial-epithelial dystrophy of the cornea, DSAEK, ultra-thin graft, excimer laser, optical coherent tomography.
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