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Hybrid femtosecond laser-assisted stromal keratoplasty: evaluation in a rabbit model

Poster Details

First Author: N.Lagali SWEDEN

Co Author(s):    M. Xeroudaki   M. Rafat   P. Fagerholm              

Abstract Details


To develop a technique of intra-stromal keratoplasty for corneal transplantation that is easily implemented and enables rapid epithelial and stromal wound healing.


Ophthalmology Department, Institute for Clinical and Experimental Medicine, Linköping University, Sweden.


23 rabbits underwent keratoplasty with the IntraLase iFs 150kHz femtosecond laser (Abbot Medical Optics, Santa Ana, CA). Half underwent a control procedure of deep anterior lamellar keratoplasty (DALK) with native rabbit corneal tissue (DALK autograft group) or a bioengineered porcine construct (BPC), (DALK BPC group). Remaining rabbits underwent a hybrid procedure to preserve epithelium, Bowman’s layer, and a thin layer of stroma to enhance healing. In this procedure a LASIK-type flap was made, followed by anterior lamellar keratoplasty in the underlying bed, using autograft tissue (FLAP-ALK autograft group) or BPC (FLAP-ALK BPC group). Rabbits were monitored for 6 mos.


All surgeries were completed successfully without complications. Initial edema subsided by 1 month in BPC groups but remained in autografts. OCT indicated faster return to normal corneal thickness and curvature with BPC than autografts. The hybrid FLAP-ALK technique better matched native corneal thickness and curvature compared to DALK. Some corneas had vessel in-growth at the time of suture removal, but vascularization and haze subsided by 6 mos. At 6 mos, FLAP-ALK groups had lower vascularization score and corneal haze than DALK groups. Both techniques supported nerve regeneration and population of cell-free BPC implants by stromal cells at 6 months.


Hybrid femtosecond laser-assisted stromal keratoplasty (FLAP-ALK) is a viable technique to implement in a preclinical setting. Compared to a standard DALK procedure, FLAP-ALK promotes a more rapid epithelial healing, less postoperative edema, a lower rate of suture-related neovascularization and a lower degree of corneal haze in the postoperative period. Additionally, the FLAP-ALK technique could be a viable method for the future implantation of bioengineered corneal substitutes. Further studies are warranted; however, the technique could find use clinically for patients with healthy endothelium where rapid wound healing and minimal epithelial disturbance is desired.

Financial Disclosure:

One or more of the authors has significant investment interest in a company producing, developing or supplying product or procedure presented, One or more of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, One or more of the authors research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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