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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

Purpose:

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

Setting:

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

Methods:

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.

Results:

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.

Conclusions:

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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