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First Author: R.Fasciani ITALY
Co Author(s): L. Mosca A. Caristia A. Agresta E. Balestrazzi
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To explore and to correlate with visual results the ultrastructural alterations after 2 lamellar keratoplasty techniques.
Ophthalmology Department, Policlinic A. Gemelli, Catholic University of Sacro Cuore, Rome.
27 eyes submitted to laser assisted lamellar keratoplasty for keratoconus (10 Femto-ALK and 17 Femto-DALK) were examined with in vivo confocal microscopy (IVCM - CONFOSCAN 4). Endothelium, residual stromal bed, donor-recipient interface and donor lamella morphological features were evaluated. A grading for interface haze and thickness as well for density and orientation of dark striae was created.
The patients were followed-up at 1,3 months and after sutures removal. No endothelial side effects were seen in all eyes. A progressive reduction of average level of light-scattering intensity and thickness of the donor-recipient interface was demonstrated, with best results in procedures that use excimer ablation (Femto-DALK). The amount of dark striae was inversely proportional to residual stromal bed thickness and simmetry. A progressive reduction in the number and orientation of dark striae was observed during the follow-up and became more evident after sutures removal, especially in Femto-DALK.
Laser procedure is used in order to improve and simplify surgical lamellar keratoplasty. In our study, the best interface quality was obtained in those lamellar procedures that used excimer laser smoothing due to a better interaction between recipient stromal bed and donor lamella with less scarring reaction and inflammation. The dark striae grading was related to surgery warp of keratoconus residual stromal bed. Lamellar procedures that reduced the thickness asymmetry of keratoconus obtained the best results due to less compression of residual stromal bed. In our results, the IVCM morphostructural evaluation seems to be useful to explain transplants optical quality assessment in Femtosecond laser lamellar keratoplasty techniques.