Ek-Alk: A Customised Femtosecond Platform For Predictable Ultrathin Endothelial Keratoplasty Grafts – One-Year Clinical Outcomes
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR289 | Type: Free paper | DOI: 10.82333/ptrk-r041
Authors: Mr Abhinav Loomba* 1 , Mr Sid Goel 1 , Mr Adam Ferguson 2 , Mr Adam Shaker 1 , Say Aun Quah 3 , Dr Ashish Khindria 4 , Ms Aoife Quah 5
1Cornea and Anterior Segment,Hull University Teaching Hospitals NHS trust,Hull,United Kingdom, 2Ophthalmology,York and Scarborough NHS trust,York,United Kingdom, 3Cornea,East Cheshire NHS Trust,Manchester,United Kingdom, 4Cornea and Anterior Segment,Birmingham NHS Trust,Birmingham,United Kingdom, 5Queens University Belfast,Belfast,United Kingdom
Purpose
To evaluate the safety, reproducibility, and one-year clinical outcomes of EK-ALK, a novel femtosecond laser–based graft preparation technique designed to deliver highly predictable ultrathin endothelial keratoplasty grafts for DSAEK.
Setting
Hull Royal Eye Hospital NHS Trust
Methods
This retrospective consecutive case series included 70 eyes of 70 patients undergoing DSAEK using donor grafts prepared via a customised adaptation of the anterior lamellar keratoplasty (ALK) mode on a femtosecond laser platform.
Donor corneas (endothelial cell density >2000 cells/mm²) were mounted on an artificial anterior chamber and dissected using customised EK-ALK parameters to achieve targeted ultrathin graft profiles. Grafts were punched, separated, and transplanted using standard DSAEK technique.
Primary endpoints included graft thickness reproducibility, intraoperative handling characteristics, postoperative complication profile, and best-corrected visual acuity (BCVA) at 1 year.
Results
Mean patient age was 72.4 years (34 male, 36 female).
Ultrathin graft creation (<100 μm) was achieved in 100% of cases, with a minimum thickness of 40 μm. Partial manual dissection was required in only 4.3% of cases, demonstrating high procedural precision and reproducibility. No intraoperative graft loss or complications occurred.
At one year, postoperative complications were limited and clinically manageable (17.4%): elevated intraocular pressure (8.7%), transient corneal oedema (4.3%), and cystoid macular oedema (4.3%).
BCVA demonstrated sustained postoperative improvement at one year, supporting the optical benefit of consistently ultrathin graft architecture.
Conclusions
EK-ALK enables a standardised, femtosecond-assisted approach to predictable ultrathin endothelial graft preparation, addressing variability inherent to conventional microkeratome or manual techniques.
To our knowledge, this represents one of the largest reported clinical series of femtosecond laser–assisted customised ultrathin graft preparation in DSAEK.
One-year outcomes confirm that EK-ALK is safe, reliable, and clinically effective, and may represent an important step toward greater standardisation and optimisation of ultrathin endothelial keratoplasty.