Because the Femtosecond laser is able to cut corneal tissue at precise depths and in a variety of patterns, it has brought significant improvements to the outcomes of corneal transplantation eye surgery since its introduction. Penetrating keratoplasty (PK), one of the more established techniques, has benefited greatly from the technology.
Femtocecond laser technology also enables surgeons to divide donated corneal tissue into anterior and posterior lamellar segments for use in partial thickness and Descemet-stripping endothelial keratoplasty (DSAEK).
Anterior Lamellar Keratoplasty (ALK) is a partial thickness grapht utilizing Femtosecond laser technology to selectively remove the diseased anterior layers of the cornea and preserves the two healthy innermost layers, the endothelium and Descemet’s membrane. As the inner layers are retained the body does not recognize the donor tissue, hence there is less risk of rejection. This technique is typically used for the treatment of Keratoconus.
DSAEK is a new corneal graft transplant technique where the unhealthy, diseased, posterior portion of a patient’s cornea is removed and replaced with healthy donor tissue obtained from the eye bank. Unlike conventional corneal transplant surgery known as penetrating keratoplasty (PK), the DSAEK procedure utilises a much smaller surgical incision and requires fewer corneal sutures. This usually results in more rapid visual rehabilitation for the DSAEK patient and also better post-operative visual acuity.
DSAEK is indicated for those patients who have corneal pathology located on the posterior aspect of their cornea known as the endothelial layer. This most commonly occurs in patients who have sustained trauma to the endothelial layer during complicated cataract surgery or patients who have an inherited disease of the corneal endothelium known as Fuchs’ Endothelial Dystrophy. It is also indicated for patients with endothelial rejection and bullous keratopathy.
Deep anterior lamellar keratoplasty (DALK) is a partial-thickness corneal transplant procedure that replaces the corneal stroma with a donor stroma while leaving the recipient’s Descemet membrane and endothelium in place. It is an effective way to treat corneal diseases when the native endothelium is intact and functioning normally. Leaving the endothelium intact decreases the risk of endothelial rejection.
Dr. Krüger uses the “big bubble” technique in DALK cases. After making a tiny opening in the stroma, air is injected to create a bubble at its anterior, which causes the stromal layers to detach from Descemet’s membrane. This technique makes the dissection process more consistent and predictable.
Like he does in PK, ALK and DSAEK, Dr. Krüger uses femtosecond laser technology for the corneal grafts.