Clinical results of posterior lamellar femto-keratoplasty in patients with corneal endothelial dystrophies
Purpose - to evaluate clinical results of posterior lamellar keratoplasty performed with Russian femtosecond laser «Vizum» for treating patients with primary and secondary corneal endothelial dystrophies. Material and methods. The study included 30 operated eyes: 10 with Fuch’s primary endothelial dystrophy of the cornea and 20 with secondary endothelial dystrophy. Patients were examined on the 7th day, as well as at 3, 6, 12 and 24 months after the surgery. All 28 patients (30 eyes) were followed-up for 12 months, 12 patients (14 eyes) were followed-up for 24 months. Results. In 3 months after the surgery, transparent engraftment was observed in most cases. In 1 case, its primary failure was diagnosed and repeated keratoplasty was performed. Postoperative haze in host-donor interface was observed in 1 case. Central corneal thickness (CCT) was 554±43 µm. Transplant thickness in the central zone was 80±13 µm. The amount of eyes with Best Spectacle-Corrected Visual Acuity (BSCVA) of 0.3 was 43%. Endothelial cells density (ECD) was 1538±500 cells/mm2. Endothelial cells loss amounted to 30.4%. By the 12th month, recipient's cornea and the transplant remained transparent in all cases. Haze in the host-donor interface was still observed in 1 case. CCT was 581±47 µm, transplant thickness was 80±16 µm. The amount of eyes with BSCVA of 0.3 was 53%. Keratometry astigmatism was 2.08±1.47 D, refractive astigmatism - 1.72±0.83 D. ECD was 1324±383 cells/mm2. Endothelial cells loss amounted to 40.1%. At 24th months after the surgery (12 patients, 14 eyes) the recipient’s cornea and the transplant remained clear in all cases. CCT was 591±48 µm, transplant thickness was 81±15 µm. Amount of eyes with BSCVA of 0.3 was 71.4%. ECD was 1426±422 cells/mm2. Endothelial cells loss - 35.1%. Conclusions. The predictability of applanation and high quality of cutting of the «Vizum» femtosecond laser assure the predictability of the process of preparing an ultrathin cornel graft from the endothelial side. Clinical results have demonstrated its effectiveness for rehabilitation of visual functions (up to BSCVA 1.0).