title: [Excimer laser-assisted lamellar endothelial keratoplasty (ExALEK): Technique and results].
abstract: BACKGROUND
  The purpose of this study is to describe a technique for thin endothelial lamellar keratoplasty and to present the results for endothelial transplant performed at the University Hospital of Nantes.
  
  
  METHODS
  This paper is a retrospective, single-center descriptive study conducted at the University Hospital of Nantes from September 2010 to May 2014, at first for anatomical or analgesic indications (group 1) and then extended to visual indications (group 2). Patients were followed for 12 months. The preparation of the endothelial graft includes an excimer-laser ablation of the residual stromal bed after lamellar keratectomy by manual deep anterior approach.
  
  
  RESULTS
  Seventy surgeries were analyzed. The etiologies were mainly Fuchs Dystrophy, secondary endothelial dystrophy and post-penetrating keratoplasty endothelial failure. Fifty-three patients were integrated in group 1 and seventeen patients in group 2. In group 1, the mean VA at 12 months was 0.70 ± 0.30 Log MAR (0.2 decimal equivalent). In group 2, the mean VA at 12 months was 0.28 ± 0.12 Log MAR (0.5 decimal equivalent). Pachymetry decreased from 740 ± 125.1 μm preoperatively to 613.4 ± 73.4 μm at 12 months. The average central thickness of the graft was 84.1 ± 28.9 μm at 1 month and 80.2 ± 29.4 μm at 12 months.
  
  
  CONCLUSIONS
  The advantage of this new surgical technique is that it is a rapid and repeatable method allowing thin grafts with satisfactory functionality and easy handling. Its performance independent of the scheduled surgery, allows for predictable organization in the operating room.
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France. Electronic address: a.bonissent@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Bonissent
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: B
authors.initials: B
authors.lastname: Vabres
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: I
authors.initials: I
authors.lastname: Orignac
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: E
authors.initials: E
authors.lastname: Martin
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: L
authors.initials: L
authors.lastname: Libeau
authors.affiliation: Banque multi-tissus, plateau de Biologiedu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: D
authors.initials: D
authors.lastname: Heymann
authors.affiliation: Service anatomie pathologique B, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Ducourneau
authors.affiliation: Clinique ophtalmologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000473:pathology / Q000601:surgery; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000637:transplantation*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity
keywords: Descemet's stripping automated endothelial keratoplasty (DSAEK); Dystrophie de Fuchs; Endothelial keratoplasty; Excimer-laser; Fuchs Dystrophy; Graft thickness; Greffe endothéliale; Greffe lamellaire postérieure; Laser Excimer; Posterior lamellar keratoplasty; Épaisseur de greffe