Evaluation Of Clinical Outcomes For Femtosecond Laser Assisted Endothelial Keratoplasty Using Customised Anterior Lamellar Keratoplasty Mode (Ek-Alk)
Published 2025 - 43rd Congress of the ESCRS
Reference: PPE.08 | Type: ESONT Abstract | DOI: 10.82333/8ckr-jf48
Authors: Andrew Shaker*, Aoife Quah 1 , Abhinav Loomba 2 , Sid Goel 2 , Say Aun Quah 3
1Unviersity of Manchester,Manchester,United Kingdom, 2Hull University Teaching Hospitals NHS Trust ,Hull,United Kingdom, 3The Wilmslow Hospital,Manchester,United Kingdom
Purpose
To assess the outcomes of a novel surgical technique in graft preparation for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). This technique, named EK-ALK (endothelial keratoplasty - anterior lamellar keratoplasty), customises the ALK mode on the femtosecond laser software when preparing donor grafts.
Setting
In this study, patients underwent their operation including pre- and post-operative care at the Hull Royal Infirmary Eye Hospital in the United Kingdom.
Methods
This was a retrospective case series looking at 23 patients assessing outcomes following DSAEK with EK-ALK mode graft preparation. Donor grafts were prepared on an artificial anterior chamber using EK-ALK mode on the femtosecond laser platform. This allowed customised preparation of thin grafts which were punched, separated and used in a subsequent endothelial keratoplasty. Visual acuities (VA), complications and clinical outcomes were noted over a three-month period post-operatively. Grafts were sourced from an eye bank locally and all had endothelial cell counts >2000cells/mm2.
Results
In this sample there were 11 males and 12 females with a mean age of 72.4 years. All grafts prepared by EK-SALK were successfully implanted into the recipient eyes. Manual dissection was not required when using this method except for in one case. Outcomes following surgery were favourable with complications in 4 cases. Of these there were 2 cases of raised IOP, 1 of corneal oedema and 1 post-operative CMO. Pre-operatively, the mean visual acuity was 0.994 LogMAR (SD, 0.615) and post-operatively it was 0.755 LogMAR (SD, 0.506).
Conclusions
Femtosecond laser machines provide the advantage of increased precision during preparation of donor corneal buttons allowing surgeons to create reproducible thin grafts. This study finds the customisable EK-ALK mode of preparing grafts safe and efficient producing thin grafts for DSAEK. This method provides an easier method of separation avoiding the need for manual dissection.