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First Author: R.Fasciani ITALY
Co Author(s): L. Spadea L. Mosca A. Caristia S. Ambrogio E. Balestrazzi
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To evaluate in vivo confocal microscopic features seen in patients that underwent to Corneal Lamellar Ablation for transplantation (CLAT) and to Femtosecond Anterior Lamellar Keratoplasty (FALK).
Ophthalmology Department, Policlinic A. Gemelli, Catholic University of Sacro Cuore , Rome.
53 patients, affected by mild to moderate keratoconus, were submitted to lamellar keratoplasty: 30 eyes of 30 patients to CLAT (iVIS Technologies, Taranto, Italy) and 18 eyes to FALK (INTRALASE, Abbott, USA). All the patients were evaluated using CS4 confocal microscopy. Using 40x lens and Z-ring device of CS4, a morphological evaluation of interface and stromal and endothelial tissue trophism and a pachimetry study of ablation and residual bed thicknesses were performed at 2 months and 1 year after surgery.
No endothelial cell density difference was seen between CLAT and FALK procedures. The morphological features of lamella and donor-recipient interface were similar in both lamellar keratoplasty techniques with progressive improvement of keratocites and corneal nerves density, reduction of inflammation stromal scattering and edema. Marked folds in the residual stromal bed were present in both procedures, but they were less evident in CLAT patients, expecially after sutures removal, but they still remained in FALK. Probably, in FALK those folds were mainly due to lamellar graft compression of keratoconus, instead of CLAT patients where the folds depended on suture traction forces.
Confocal microscopy seems to be a useful procedure to investigate in vivo the results of keratoplasty surgery. The morphological analysis of the tissues permits a direct evaluation and comparison between the different keratoplasty techniques