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Femtosecond laser mini-bubble technique may enhance DSEK, DALK interfaces
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CHICAGO — Low femtosecond laser pulse energy and wide spot spacing may enable a novel method of donor preparation for ultra-thin Descemet stripping endothelial keratoplasty and donor and host dissection in deep anterior lamellar keratoplasty, a speaker said here.
The mini-bubble technique is an alternative to the big-bubble technique, Roger F. Steinert, MD, OSN Cornea/External Disease Board Member, explained during the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology.
“We can have the potential for a more reliable technique than big bubble. It also has implications for a potential method of donor preparation for a very thin DSEK or almost DMEK type of tissue by central eye banks that could supply it to you already pre-cut and ready to go,” Steinert said.
The big-bubble technique involves a bare Descemet’s membrane, which eliminates stromal interface issues. Success rates in obtaining a big bubble are low, and compression wrinkles can be problematic, particularly in cases of keratoconus, Steinert said.
Steinert and colleagues mounted human corneas on an artificial anterior chamber. They used an IntraLase iFS 150-kHz femtosecond laser (Abbott Medical Optics) to perform cuts with varied spot spacing and pulse energy of 3.5 mJ. Steinert and colleagues performed eight laser passes, rotating raster and spiral patterns.
Investigators used optical coherence tomography to measure stromal thickness and scanning electron microscopy to detect endothelial cell loss.
Testing showed that the micro-bubbles helped peel apart interconnected stromal layers. The Descemet’s stromal interface was smooth, similar to a LASIK flap; no evidence of endothelial cell loss was seen, Steinert said.
Disclosure: Steinert is a consultant to Abbott Medical Optics.