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

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.