title: Visual outcome and histological findings following femtosecond laser-assisted versus microkeratome-assisted DSAEK.
abstract: BACKGROUND
  The aim of this study was to compare the visual outcome of femtosecond laser-assisted Descemet stripping automated endothelial keratoplasty (DSAEK) to microkeratome-assisted DSAEK as well as to contrast precut versus surgeon-cut grafts. Histologic characterization of failed DSAEK grafts was performed in order to correlate ultrastructural changes with graft failures.
  
  
  METHODS
  In this case control study, 47 cases of DSAEK were investigated in terms of visual acuity, keratometric astigmatism, spherical equivalent, endothelial cell count, and postoperative complications. We formed three groups: the femtosecondlaser-assisted DSAEK with precut grafts, the microkeratome-assisted DSAEK with precut and with surgeon-cut grafts. Mean follow-up was 6 months. In the case of graft failure, penetrating keratoplasty was performed, and the excised corneal buttons were investigated by light and electron microscopy.
  
  
  RESULTS
  Microkeratome-assisted DSAEK lead to better visual outcome than femtosecond laser-assisted DSAEK. Keratometric astigmatism, spherical equivalent and endothelial cell count did not differ significantly between both methods. Precut and surgeon-cut grafts in microkeratome-assisted DSAEK did not show any significant difference regarding all upraised parameters. No definite histological correlate for graft failure following femtosecond laser-assisted DSAEK was found.
  
  
  CONCLUSIONS
  Femtosecond laser-assisted DSAEK is not the method of choice, and needs further technical improvement. However, failed femtosecondlaser-assisted DSAEK grafts did not show significant histological changes related to the technique to explain reduced visual acuity. In microkeratome-assisted DSAEK, the preparation time point of the graft does not seem to influence the visual and optical outcome.
authors: University Eye Hospital Freiburg, Killianstr. 5, 70106 Freiburg im Breisgau, Germany. sonja.heinzelmann@uniklinik-freiburg.de
authors: S
authors: S
authors: Heinzelmann
authors: P
authors: P
authors: Maier
authors: D
authors: D
authors: Böhringer
authors: C
authors: C
authors: Auw-Hädrich
authors: T
authors: T
authors: Reinhard
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000209:etiology; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D002452:Cell Count; D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000601:surgery / Q000648:ultrastructure*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000378:metabolism / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D009924:Organ Culture Techniques; D012086:Reoperation; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D015415:Biomarkers
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