title: Femtosecond and excimer laser-assisted endothelial keratoplasty (FELEK): a new technique of endothelial transplantation.
abstract: OBJECTIVE
  To describe a new technique of endothelial keratoplasty (EK) that improves the quality of lamellar dissection of donor cornea.
  
  
  METHODS
  We compared four techniques of donor cornea preparation for lamellar dissection on 8 donor corneas: mechanical dissection with a microkeratome, a single femtosecond laser lamellar cut, a double femtosecond laser lamellar cut and combined femtosecond laser lamellar dissection with excimer laser surface photoablation. The quality of the donor cornea interface was assessed and compared using scanning electron microscopy (SEM), and the most satisfactory technique was employed for EK on three patients. The postoperative anatomic results were analyzed with anterior segment spectral-domain optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM).
  
  
  RESULTS
  The smoothest stromal interface was observed on SEM with the combined use of femtosecond laser dissection and excimer photoablation. The surgical procedures performed with donor cornea prepared by a combination of femtosecond and excimer lasers resulted in clear corneas after 1 month. SD-OCT showed good attachment of the endothelial graft and a hyperreflective interface. On IVCM, subepithelial haze, honeycomb-like activated keratocytes and needle-shaped particles were visible in the recipient corneal stroma as well as numerous hyperreflective particles on the donor-recipient interface.
  
  
  CONCLUSIONS
  A new technique, femtosecond and excimer laser-assisted endothelial keratoplasty (FELEK), which refines the current limitations observed in Descemet-stripping automated endothelial keratoplasty (DSAEK), is described. Femtosecond laser dissection provides a thin and reproducible endothelial graft cut with a high level of safety and accuracy, while excimer photoablation yields a smooth, high-quality interface.
authors.affiliation: Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France. Electronic address: trinhdinhliem@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Trinh
authors.affiliation: Inserm U705, UMR CNRS 8206, faculté des sciences pharmaceutiques et biologiques, 4, avenue de l'Observatoire, 75270 Paris cedex 06, France; Plateau technique d'imagerie cellulaire et moléculaire, IFR71-IMTCE, faculté des sciences pharmaceutiques et biologiques, université Paris Descartes, 4, avenue de l'Observatoire, 75270 Paris cedex 06, France.
authors.forename: B
authors.initials: B
authors.lastname: Saubaméa
authors.affiliation: Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Auclin
authors.affiliation: Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Vision Institute, Inserm UMR S 968, UMR 7210, université Pierre-et-Marie-Curie - Paris 6, 17, rue Moreau, 75012 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Denoyer
authors.affiliation: Plateau technique d'imagerie cellulaire et moléculaire, IFR71-IMTCE, faculté des sciences pharmaceutiques et biologiques, université Paris Descartes, 4, avenue de l'Observatoire, 75270 Paris cedex 06, France.
authors.forename: R
authors.initials: R
authors.lastname: Lai-Kuen
authors.affiliation: Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: El Hamdaoui
authors.affiliation: Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Vision Institute, Inserm UMR S 968, UMR 7210, université Pierre-et-Marie-Curie - Paris 6, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise-Paré Hospital, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France; AP-HP, University of Versailles - Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France.
authors.forename: A
authors.initials: A
authors.lastname: Labbé
authors.affiliation: Department of Pharmacy, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France.
authors.forename: M-C
authors.initials: MC
authors.lastname: Despiau
authors.affiliation: Vision Institute, Inserm UMR S 968, UMR 7210, université Pierre-et-Marie-Curie - Paris 6, 17, rue Moreau, 75012 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Brignole-Baudouin
authors.affiliation: Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; Vision Institute, Inserm UMR S 968, UMR 7210, université Pierre-et-Marie-Curie - Paris 6, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise-Paré Hospital, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France.
authors.forename: C
authors.initials: C
authors.lastname: Baudouin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000637:transplantation* / Q000648:ultrastructure; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D053685:Laser Therapy; D054018:Lasers, Excimer; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D013997:Time Factors
keywords: Cornea; Corneal graft; Cornée; Endothelial keratoplasty; Excimer laser; Femtosecond laser; Greffe de cornée; Kératoplastie endothéliale; Laser excimer; Laser femtoseconde