Abstract

SA.09.10

DSAEK with the Carriazo-pendular-microkeratome and an artificial anterior chamber – experimental and first clinical results

Jan Darius Unterlauft1, Johann Schmiedl2, Berit Meinhardt1, Gunda Kann1, Gerd Geerling1
1Universitäts-Augenklinik Würzburg, 2Schwind-Eye-Tech Solutions, Kleinostheim

Objective
Descemet stripping endothelial keratoplasty (DSAEK) is an alternative to penetrating keratoplasty (PK) for the treatment of pathologically altered corneal endothelium. We present here our first experimental and clinical DSAEK-results using the Carriazo-pendular-microkeratome and a newly designed artificial anterior chamber.
Methods
Porcine corneo-scleral discs were fixed in the new artificial anterior chamber and kept under constant pressure of 100 or 200 mbar using a water column. Microkeratome-cuts of 300, 350 and 400 µm thickness were performed in groups of n= 5 corneas each. The thickness of the cornea before and after cutting as well as the thickness of the resulting corneal lamella was measured with an ultrasound pachymeter. In three human eyes (of 3 patients) a corneal lamella with a thickness of 400 µm and a diameter of 10 mm were cut. For these 3 cases uncorrected and best-corrected visual acuity, manifest refraction, intraocular pressure, endothelial cell density, corneal topography, aesthesiometry and pachymetry are measured before, 1 day, 1 and 6 weeks as well as 3, 6, and 12 months after DSAEK.
Results
In the porcine model using 100 (200) mbar of pressure in the artificial anterior chamber corneal lamellae of 437±50 (486±11) µm, 370±27 (398±11) µm und 300±7 (324±10) µm were cut using the 300, 350 and 400 µm microkeratome. In all 3 DSAEK-cases the lamellar corneal dissection could be performed and the posterior lamellar discs could be prepared, imported and fixed to the host´s corneal bed without any serious complications. Follow-up results of the ongoing study will be presented.
Conclusions
Endothelial keratoplasty with manually dissected (DSEK) and automatically dissected (DSAEK) corneal lamellae are commonly used methods. DSAEK can be performed using the Carriazo-pendular-microkeratome and the newly designed artificial anterior chamber. The thickness of the corneal lamella depends on the pressure in the artificial anterior chamber.

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