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Microkeratome-assisted versus femtosecond laser-assisted Descemet's stripping endothelial keratoplasty: morphological and functional results during one year follow-up

Poster Details

First Author: L.Guccione ITALY

Co Author(s):    L. Mosca   S. Luceri   A. Caristia   R. Secondi   R. Fasciani   A. Caporossi

Abstract Details


To compare the Microkeratome-assisted endothelial keratoplasty (DSAEK) to the Femtosecond laser-assisted endothelial keratoplasty (Femto-DSEK), analyzing the morphological and functional findings during one year follow up.


Catholic University of 'Sacro Cuore' of Rome - Italy.


Fifty patients with corneal edema due to endothelial decompensation, were submitted to endothelial keratoplasty: 26 eyes of 26 patients were submitted to DSAEK (15M and 11F; mean age: 69.3 years ± 11.8SD; preoperative BSCVA as LogMAR charts: 0.99); 14 eyes were Fuchs' endothelial corneal dystrophy (FECD), 8 eyes were bullous keratopathy and 4 eyes were decompensation of a previous keratoplasty. Corneal buttons from donor were performed with a Moria microkeratome. 24 eyes of 24 patients were submitted to Femto-DSEK (13M, 11F; mean age 71.1 years ± 13.3SD; preoperative BSCVA: 1.06) 10 patients were FECD, 9 eyes were bullous keratopathy and 5 eyes were decompensation of a previous keratoplasty. The donor lamella was obtained starting from an entire donor cornea, using a 60 kHz Femtolaser with Double Raster pattern of 9 mm diameter at 400 microns of depth. Then, the button was punched with 8.5 mm diameter corneal trephine. Then the button was inserted into the recipient anterior chamber using the Busin glide and fixed into the posterior stroma with air bubble. Average of graft central thickness and rate of endothelial cell loss were measured using CS4 confocal microscopy. BSCVA and postoperative complications were evaluated.


The average of graft central thickness at 1 and 12 months follow up was 125 μm ± 23 SD and 112 μm ± 18 respectively in the DSAEK group; 137 μm ± 29 SD and 115 μm ± 24 SD respectively in the Femtosecond laser-assisted group. The rate of endothelial cell loss comparing the DSAEK group to the Femto-DSEK group at 1, 6 and 12 months follow up was 20.1% ± 9.1 SD vs 16% ± 8.5 SD (p<0.01); 20.3% ± 6 SD vs 19.1 % ± 10 SD (p=0.43) and 33.6% ± 13.2 SD vs 33.5% ± 13.7 SD(p<0.01) respectively. The BSCVA as LogMAR charts in the DSAEK group compared to the Femto-DSEK group was 0.44 vs 0.72 (p=0.45), 0.29 vs 0.52 (p=0.53) and 0.16 vs 0.31 (p=0.68) at 1, 6 and 12 months follow up respectively. Postoperative complications in the DSAEK group were pupillary block in 3.8% of patients and graft detachment in 7.69% of patients, while 3.8% patients of the Femto-DSEK group showed a pupillary block.


There are no statistically significant differences between Microkeratome-assisted and Femtosecond laser-assisted Descemet stripping endothelial keratoplasty in terms of visual outcomes, endothelial cell loss, graft central thickness during one year follow up. FINANCIAL INTEREST: NONE

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