**5. Conclusions**

Both the femtolaser assisted ALK and DALK techniques seem to be effective in restoring a clear and normal cornea with a good recovery one year after surgery with a mean BSCVA of 0.60 and 0.80, respectively. The Femto-DALK technique resulted more rapid in recovery time and more effective with results comparable to the manual descemetic DALK technique.

With the new femtosecond lasers machines developed by different manufacturers, femtolaser-assisted Anterior Lamellar Keratoplasties will be available to more surgeons.

The development of the femtosecond laser softwares and the possible association with scanning topography systems could help in performing customized treatment to the single cornea, improving the results reached with the empirical femtolaser-assisted ALK techniques.

Moreover, femtosecond laser allows to perform precise lamellar thickness graft for posterior lamellar keratoplasty. This application of the femtosecond laser showed good results especially associated with the Busin folder "pull-in" technique.

The femtosecond laser showed to be a dynamic surgical tool, enabling surgeons to perform safe and reproducible anterior and posterior lamellar keratoplasty procedures.

Nevertheless, we must be cautious in the application of this exciting technology, remembering that it is still "a work in progress" and the preliminary results need to be evaluated by longer follow-up.

### **6. References**

90 Keratoplasties – Surgical Techniques and Complications

Fig. 19. Optical Coherent Tomography (on the left) of Femto-DLEK shows perfect

To avoid the problems of the endothelial lamellar dislocation (Figure 15) and the presence of the "step" between donor and recipient (Figure 18), we tried to perform a Femto-DLEK technique (basing on the Melles' manual DLEK technique) using the femtosecond laser to perform the endothelial lamellar cut both in the donor cornea and the recipient one 18. In this way we tried to realize a perfect "match" between donor and recipient cornea with the donor lamella "inserted" in the recipient bed (Figure. 19), but the stroma-stroma interface resulted in a hard scarring showing low visual results (0.3 or little more) with patient

Both the femtolaser assisted ALK and DALK techniques seem to be effective in restoring a clear and normal cornea with a good recovery one year after surgery with a mean BSCVA of 0.60 and 0.80, respectively. The Femto-DALK technique resulted more rapid in recovery time and more effective with results comparable to the manual descemetic

With the new femtosecond lasers machines developed by different manufacturers, femtolaser-assisted Anterior Lamellar Keratoplasties will be available to more surgeons. The development of the femtosecond laser softwares and the possible association with scanning topography systems could help in performing customized treatment to the single cornea, improving the results reached with the empirical femtolaser-assisted ALK

Moreover, femtosecond laser allows to perform precise lamellar thickness graft for posterior lamellar keratoplasty. This application of the femtosecond laser showed good results

The femtosecond laser showed to be a dynamic surgical tool, enabling surgeons to perform

Nevertheless, we must be cautious in the application of this exciting technology, remembering that it is still "a work in progress" and the preliminary results need to be

safe and reproducible anterior and posterior lamellar keratoplasty procedures.

"matching" of donor lamella like an "insert" into the recipient bed.

dissatisfaction that required a PK and we abandoned this technique.

especially associated with the Busin folder "pull-in" technique.

**5. Conclusions** 

DALK technique.

techniques.

evaluated by longer follow-up.


**6** 

*China* 

**Descemet's Stripping with Automated** 

*Department of Ophthalmology, Peking University Third Hospital, Beijing,* 

Hui-Jin Chen, Yan-sheng Hao and Jing Hong

**Endothelial Keratoplasty (DSAEK) in Patients** 

**with Black Diaphragm Intraocular (BDI) Lens** 

A stable anterior chamber is a crucial factor to DSAEK. In aniridic patients with BDI lens, the anterior and posterior segment has direct communication at the periphery of the BDI lens. Maintenance of the air bubble in the anterior chamber would be problematic. Pressure equilibrium must be established on both sides of the BDI lens before the air bubble is

Compared with traditional full-thickness keratoplasty, endothelial keratoplasty (EK) is a great breakthrough for the treatment of corneal endothelial disorders because this new technique maintains a more regular corneal anterior surface, preserves more corneal biomechanical tensile strength and provides more rapid visual rehabilitation. Descemet's stripping with automated endothelial keratoplasty (DSAEK) is currently most favored procedure of EK, in which the donor disc dissection was performed with an automated microkeratome that allows smoother interface and more accurate control of graft thickness. A stable iris-lens diaphragm is essential to intraoperative donor unfolding and maintenance of air in the anterior chamber, and thus a critical factor for DSAEK. Although it was once considered as a relative contraindication, DSAEK has begun to be undertaken in patients in

 In the past decade, patients with aniridia and aphakia/cataract were treated with black diaphragm intraocular (BDI) lens which is composed of a central optic surrounded by a black diaphragm and 2 haptics. This lens could alleviate the patients' symptom of glare and photophobia and increase vision. However, this BDI lens differs from the natural iris-lens diaphragm for more rigidity and less compliance. Besides, the chamber anterior to the BDI lens has direct communication with the vitreous cavity at the gap between the diaphragm and haptics of the lens. Difficulties may be encountered in maintaining the air bubble in the anterior chamber. Herein, we present 3 consecutive cases of bullous keratopathy with BDI lens who underwent DSAEK, the etiologies included 1 congenital aniridia and 2 traumatic iris loss.

A 50-year-old man present with bullous keratopathy in his left eye. He had a history of left corneal laceration in 2000, and underwent black diaphragm intraocular (BDI) lens

whom the iris-lens diaphragm was anatomically or functionally abnormal.1,2,3

**1. Introduction** 

**2. Case report** 

**2.1 Case 1** 

introduced into the anterior chamber.

[18] Mehta JS, Shilbayeh R, Por YM, Cajucom-Uy H, Beuerman RW, Tan DT. Femtosecond laser creation of donor ornea buttons for Descemet-stripping endothelial keratoplasty. J Cataract Refract Surg. 2008 Nov;34(11):1970-5
