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Femtosecond Laser-Assisted Deep Lamellar Descemet Membrane Endothelial Keratoplasty for the Treatment of Endothelial Dysfunction Associated With Posterior Stromal Scarring

Alió del Barrio, Jorge L., MD, PhD, FEBOS-CR*,†; Vargas, Verónica, MD*

doi: 10.1097/ICO.0000000000001829
Case Report
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Purpose: To describe an alternative surgical approach, femtosecond laser-assisted deep lamellar Descemet membrane endothelial keratoplasty (Femto-DL-DMEK), for the treatment of corneal endothelial diseases associated with posterior stromal scarring.

Methods: Case report of a 52-year-old man with pseudophakic bullous keratopathy and posterior corneal scarring secondary to viral endotheliitis who underwent Femto-DL-DMEK. The surgical technique was as follows: First, a manual lamellar dissection plane was created at approximately 75% to 85% depth through a 5.0-mm superior scleral incision. One week later, using a femtosecond laser, an intersecting posterior side cut of 8.2 mm diameter was created. Subsequently, the dissected posterior recipient disk was removed from the anterior chamber through a 3.2-mm limbal incision. Finally, an 8.0-mm DMEK graft was placed.

Results: The patient's uncorrected distance visual acuity improved from 20/200 (0.15; decimal) preoperatively to 15/25 (0.6) after surgery; corrected distance visual acuity improved from 20/200 (0.15) to 20/25 (0.9) with a residual refraction of +1.0–0.50 at 140 degrees. Endothelial cell count was 2062 cell/mm2 6 months after surgery. No intra- or postoperative complications were noted.

Conclusions: As long as the anterior and mid-stroma are unaffected, those with endothelial diseases associated with opacification of the posterior stroma can benefit from endothelial keratoplasty through a Femto-DL-DMEK procedure, avoiding all well-known drawbacks of penetrating keratoplasty.

*Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain; and

Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain.

Correspondence: Jorge L. Alió del Barrio, MD, PhD, FEBOS-CR, Avda de Denia s/n, Edificio Vissum, Alicante 03016, Spain (e-mail: jorge_alio@hotmail.com).

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com).

Received September 13, 2018

Accepted October 31, 2018

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