Femtosecond Laser-Assisted Endothelial Keratoplasty: A Case Comparison Of Endothelial Keratoplasty (Ek) Mode Versus Customised Superficial Anterior Lamellar Keratoplasty (Salk) Mode In Graft Preparation.

The purpose of this poster is to describe a case comparison highlighting clinical outcomes, and practical advantages and disadvantages of femtosecond laser EK mode versus customised SALK mode in graft preparation for patients undergoing endothelial keratoplasty.

All patients involved were assessed, managed and followed up locally by clinical members of the corneal team at the Hull Royal Eye Hospital. 

Femtosecond-assisted graft preparation was used for four patients undergoing endothelial keratoplasty. Donor tissue was mounted on an artificial anterior chamber and docked on the femtosecond laser platform. Two of these grafts were prepared using EK mode and two were prepared using customised SALK mode. Graft tissue was manually punched, separated and used to complete the EK. Practical advantages and disadvantages of each mode were noted by the surgeon. Additionally, clinical outcomes including visual acuity and incidence of complications were collected over a 3 month post-operative period.

All grafts were successfully prepared using the femtosecond laser. Surgeons noted that separation of graft tissue using the customised SALK mode was easier, consistent and more predictable compared to the EK mode. EK mode cause more trauma during graft separation and unpredictable outcomes post operatively. 

The use of Femtosecond laser customised SALK mode may provide an innovative alternative to standard EK mode with practical benefits to the surgeon and superior clinical outcomes to patients. EK mode graft tissue preparation was more traumatic and difficult to separate compared to customised SALK mode. In addition customised SALK mode had better graft clarity and visual outcomes compared to EK mode.