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Clear Cornea Femto DALK: a novel technique for performing deep anterior lamellar keratoplasty

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Abstract

Purpose

A new femtosecond laser assisted deep anterior lamellar keratoplasty technique (Clear Cornea Femto DALK or CCF DALK) can be performed with less technical challenges compared to conventional procedures. This paper reports on a preliminary case series to evaluate the technique.

Method

First, through a clear cornea approach, Descemet’s membrane (DM) is completely separated from posterior stroma by injection of balanced salt solution/viscoelastic substance through a special cannula inserted into the deep stroma and positioned right above the DM without perforating. The injection creates a liquid chamber that detaches the DM while preserving a reasonably transparent corneal stroma. Afterwards, a complete posterior/anterior trephination of the stroma, from the liquid chamber to the epithelium, is done using a femtosecond laser system under optical coherence tomography control.

Results

This technique was successfully performed in a preliminary series of 10 eyes/10 patients. All patients had the DM completely bared and kept their own endothelial cell population with minimal cell loss (< 15%) after 6 months. Postoperative interface reaction was minimal, and no immune reactions were observed thus far.

Conclusion

Clear Cornea Femto DALK is a promising alternative to previous Femto DALK procedures with good acceptance of the tissue seen to date.

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Author information

Authors and Affiliations

  1. Augenklinik Am Neumarkt, Private Eye Clinic, Schildergasse 107-109, 50667, Cologne, Germany

    Georg Gerten & Philipp Thiée

  2. MVZ Dres. Gerten & Kermani Leverkusen GmbH, Artemis Eye Center Leverkusen, Leverkusen, Germany

    Georg Gerten

  3. Laserforum Köln E.V, Cologne, Germany

    Georg Gerten, Uwe Oberheide & Philipp Thiée

  4. Technische Hochschule Köln, University of Applied Sciences, Cologne, Germany

    Uwe Oberheide & Philipp Thiée

Authors
  1. Georg Gerten
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  3. Philipp Thiée
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Contributions

Dr. Georg Gerten contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by Dr. Georg Gerten and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Georg Gerten.

Ethics declarations

Conflict of interest

Dr. Gerten is consultant to Alcon Laboratories Inc. (Fort Worth, USA), Rowiak GmbH (Hannover, Germany). Dr. Gerten is patent holder regarding mentioned devices.

Consent to participate

Informed consent was obtained from the participant.

Consent for publication

The participant has consented to the submission of the case report to the journal.

Disclaimer

The article has been presented at the 37th ESCRS in Paris, France (September 2019). The authors did not receive any financial support from any public or private sources. The authors have no financial or proprietary interest in a product, method, or material described herein beyond the above disclosed.

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Gerten, G., Oberheide, U. & Thiée, P. Clear Cornea Femto DALK: a novel technique for performing deep anterior lamellar keratoplasty. Graefes Arch Clin Exp Ophthalmol 260, 2941–2948 (2022). https://doi.org/10.1007/s00417-022-05582-0

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  • DOI: https://doi.org/10.1007/s00417-022-05582-0

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