Femtosecond laser-assisted DSEK compares favorably with manual procedure

ROME — Descemet's stripping endothelial keratoplasty with the VisuMax femtosecond laser from Carl Zeiss Meditec seems to preserve the donor endothelial cells better than the manual technique, according to one surgeon.

"We compared the results of two series of DSEK. In one group, the implanted graft was manually dissected, while in a second group, the graft was cut with the femtosecond laser at a depth of 500 µm depth in the donor cornea. In both series, implantation was performed using the Busin glide and then injecting an air bubble into the anterior chamber," George Baikoff, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.

Apart from a few minor and transient complications, the corneas rapidly regained their transparency. Six weeks after surgery, mean endothelial donor central thickness was 132 µm ± 67 µm in the femtosecond group and 176 µm ± 79 µm in the manual group. After a 2-month follow-up, mean endothelial cell density was 1,995 cells/mm² ± 909 cells/mm² in the femtosecond group and 1,285 cells/mm² ± 725 cells/mm² in the manual group.

"These results show that the VisuMax femtosecond laser-assisted DSEK is less traumatic and therefore safer. The quality of the femtosecond cut donor appeared to be better than the manually dissected one," Dr. Baikoff said.

However, he said there are some disadvantages with the laser.

"There are higher costs involved and a longer surgical time. In addition, with the currently available technology, only epithelium-parallel cuts are possible. You cannot match the cut profile with the posterior plane," he said.