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Creating endothelial lenticules with femtoseconde laser: the double layer technique
Author(s) -
BOURGES JL,
ROUSSEAU A,
SARAGOUSSI JJ,
RENARD G,
BEHARCOHEN F
Publication year - 2011
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2011.2371.x
Subject(s) - reproducibility , microkeratome , lasik , lamellar structure , materials science , laser , ophthalmology , biomedical engineering , optics , femtosecond , scanning electron microscope , excimer laser , cornea , medicine , keratomileusis , chemistry , physics , composite material , chromatography
Purpose Femtosecond laser(FS) enhances reproducibility and accuracy in corneal surgery. However, visual outcomes of Femtoseconde Lamellar Endothelial Keratoplasty (FLEK) are still impaired by lenticule irregularities. We aimed to enhance the smoothness of interface of FLEK lenticules. Methods We proceeded for corneal cuts on experimental human corneas with the 60 and 150 kHz Intralase FS (AMO, USA). Laser settings were optimized to obtain the best interface quality while delivering minimal energy to the corneal stroma. We did each procedure in triplicate with the appropiate settings to test reproducibility. We created posterior lenticules for FLEK with the following FS various cut profiles: a single path profile (SP) performing a 500µm deep full lamellar cut, a double path profile (DP) with an identical lamellar cut performed twice, a double layer profile (DL) performing two successive lamellar cuts at 350µm and then at 150 µm depth. We created 100 µm LASIK free flaps as a control. The stromal interface quality of the so‐obtained interfaces was analyzed by scanning electron microscope (SEM). Results Stromal adherences persisted after both the SP and the DP procedure, creating central irregularities on the endothelial lenticule. The DL profile created the smoothest interfaces with the best reproducibility when FS parameters for lamellar cut were set for diameter (mm), depth (µm), energy (µJ), and spot size/step (µm) respectively on 9.0mm, 350µm, 2.1µJ, 4:4µm and 8.3mm, 150µm, 0.9µJ, 4:4µm. Observed with SEM, EK lenticules created with the DL profile and LASIK flap had similarly smooth interfaces. Conclusion Femtosecond lasers can creat EK lenticules with a quality of stromal interface comparable to refractive surgery.