N.P. PASHTAEV¹, A.N. PASHTAEV², N.A. POZDEYEVA¹, A.A. SHIPUNOV¹

¹Cheboksary branch of the S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley Pr., Cheboksary, Russian Federation, 428028

²The S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskoudnikovsky blvd., Moscow, Russian Federation, 127486

 Pashtaev N.P. ― D. Med. Sc., Professor, Director, tel. (8352) 36-46-88, e-mail: prmntk@chtts.ru

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

Pozdeyeva N.A. ― D. Med. Sc., Deputy Director on Research Work, tel. (8352) 36-46-96, e-mail: npozdeeva@mail.ru

Shipunov A.A. ― Junior Researcher, tel. (8352) 49-24-11, e-mail: sashawoody@mail.ru

 The developed method of forming an ultrathin graft is based on the consistent application of femtosecond laser to remove surface layers of donor cornea by 350-400 μm depth and subsequent excimer laser ablation of the residual stroma to obtain the graft thickness of 120 μm in the central zone. The method of transplantation is standard for Descemet’s Stripping Endothelial Keratoplasty and is performed using a tunnel corneoscleral incision of 4.5 mm. The surgery of this type was performed for 2 eyes of 2 patients. The thickness of the graft after dehydration in the anterior chamber of the recipient was less than 80 μm, which corresponds to the criteria of ultrathin transplant. Corneal transparency was restored in 1 month after surgery. Corrected visual acuity in 3 months after surgery was 0.5 in the first and 0.6 in the second case, which is comparable to results of microkeratome-assisted techniques of obtaining a graft. The procedure is controlled at all stages, excludes the risk of culling the donor cornea and provides high functional outcomes 1 month after surgery. In the represented cases, the loss of endothelial cells was comparable with other methods of graft formation.

Key words: Fuchs’ dystrophy, Descemet’s Stripping Endothelial Keratoplasty, ultrathin graft, femtosecond laser, excimer laser.

References

1. Busin M., Bhatt P.R., Scorcia V. A modified technique for Descemet membrane stripping automated endothelial keratoplasty to minimize endothelial cell loss. Ophthalmol, 2008, Vol. 126, pp. 1133-1137.
2. Walter K.A., Foster J.B. Innovation in Endothelial Keratoplasty Early results from a no-fold, small-incision, DSAEK graft injector. Cataract Refract. Surg. Today, 2009, Vol. 9, 83-85.
3. Khor W.B., Mehta J.S., Tan T.D. Descemet stripping automated endothelial keratoplasty with a graft insertion device: surgical technique and early clinical results. J. Ophthalmol, 2011, Vol. 151, pp. 223-232.
4. Tan D., Mehta J. Future directions in lamellar corneal transplantation. Cornea, 2007, Vol. 26, no. 1, pp. 21-28.
5. Malyugin B.E., Moroz Z.I., Kovshun E.V., Drozdov I.V. Descemet’s Stripping Automated Endothelial Keratoplasty with the use of ultrathin grafts. Tez. dokl. 9-go s’ezda oftalmologov Rossii. Moscow, 2010, pp. 310-311. (in Russ.).
6. Malyugin B.E., Moroz Z.I., Kovshun E.V., Drozdov I.V. Analysis of clinical results Descemet’s Stripping Automated Endothelial Keratoplasty with the use of ultrathin grafts. «Filatovskie chteniya»: Mat. nauchno-prakticheskoj konferentsii, 2011, pp. 23-24. (in Russ.).
7. Koenig S.B., Covert D.J., Dupps W.J., Meisler D.M. Visual acuity, refractive error, and endothelial cell density six months after descemet stripping and automated endothelial keratoplasty (DSAEK). Cornea, 2007, Vol. 26, no. 6, pp. 670-674.
8. Neff K,D,, Biber J,M,, Holland E,J. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea, 2011, Vol. 30, no. 4. pp. 388-391.
9. Malyugin B.E., Moroz Z.I., Borzenok S.А. et al. First experience and clinical results of Descemet’s Stripping Automated Endothelial Keratoplasty utilizing the pre-cut ultrathin grafts. Oftalmokhirurgiya. 2013, 3, pp. 12-16. (in Russ.).
10. Gorovoy M. Descemet stripping automated endothelial keratoplasty. Cornea, 2006, Vol. 25, no. 8. pp. 886-889.
11. Mootha V,V,,  Heck  E,,  Verity  S,M. et al. Comparative study of Descemet stripping automated  endothelial  keratoplasty  donor  preparation  by  MoriaCBm micro keratome, horizon microkeratome, and Intralase FS60. Cornea, 2011, Vol. 30, no. 11, pp. 320-324.
12. Neroev VV, Gundorova RА, Stepanov А et al. The primary experience and short-term results of femtolaser Descemet’s Stripping Endothelial Keratoplasty (DSEK) with formation of transplant from endothelium side. Rossijskij meditsinskij zhurnal, 2013, no. 5. pp. 44-46. (in Russ.).
13. Hjortdal J., Nielsen E., Vestergaard A., Sondergaard A. Inverse Cutting of Posterior Lamellar Corneal Grafts by a Femtosecond Laser. The Open Ophthalmology Journal, 2012, no. 6, pp. 19-22.
14. Mehta J,S., Por Y,M., Poh R. et al. Comparison of donor insertion techniques for Descemet stripping automated endothelial keratoplasty. Ophthalmol, 2008, Vol. 126, no. 10. pp. 1383-1388.