Success of femtosecond laser-assisted deep anterior lamellar keratoplasty (Femto-DALK): a clinical case series of 42 eyes using an intraoperative optical coherence tomography (iOCT)-guided laser-generated pre-descemet tunnel - Scorecard - MDSpire
Clinical Scorecard: Clinical Outcomes of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty: An iOCT-Guided Pre-Descemet Tunnel Case Series of 42 Eyes
At a Glance
Category
Detail
Condition
Stromal corneal diseases with a healthy endothelium, including keratoconus, stromal scarring, and stromal dystrophies
Key Mechanisms
The reported technique uses femtosecond laser and intraoperative OCT guidance to create a pre-Descemet intrastromal tunnel for air injection during DALK.
Target Population
Patients undergoing DALK for stromal corneal disease with a healthy endothelium
Care Setting
Retrospective study at the Department of Ophthalmology, University of Düsseldorf, Germany; the excerpt states that procedures from January 2020 through December 2023 were reviewed.
Key Highlights
The study retrospectively reviewed Femto-DALK procedures performed at one center from January 2020 through December 2023 by a single surgeon.
Preoperative OCT-derived pachymetry was used to plan lamellar dissection depth, with modification in very thin corneas.
Intraoperative OCT guided the side-cut extension and pre-Descemet tunnel; the reported tunnel endpoint was approximately 30 μm anterior to Descemet membrane.
The excerpt describes the study methods but does not provide clinical outcome results.
Guideline-Based Recommendations
Diagnosis
Management
The introduction describes DALK as the preferred treatment for stromal corneal diseases when the endothelium is healthy.
The reported procedure used iOCT-guided femtosecond laser creation of a pre-Descemet tunnel followed by air injection.
Monitoring & Follow-up
Preoperative evaluation included corneal diameter, minimal pachymetry, and mid-peripheral pachymetry measurements.
Intraoperative OCT guided lamellar depth, side-cut extension, and tunnel placement.
Risks
The introduction states that creating an intrastromal tunnel near Descemet membrane carries a risk of membrane perforation and may necessitate conversion to penetrating keratoplasty.
The introduction identifies technical difficulty, conversion to penetrating keratoplasty, prolonged and unpredictable operative duration, and a steep learning curve as challenges of DALK.
Patient & Prescribing Data
Patients undergoing femtosecond laser-assisted DALK for stromal corneal disease with a healthy endothelium; the excerpt does not state the number of eyes.
General anesthesia was used for every operation. The reported procedure used iOCT guidance for tunnel placement and air injection for pneumatic dissection.
Clinical Best Practices
The reported protocol used preoperative OCT-derived pachymetry to plan lamellar dissection depth, with modification in very thin corneas.
The reported protocol used intraoperative OCT to guide tunnel placement and adjusted the trajectory to remain nearly parallel with Descemet membrane.
The excerpt does not describe the procedure after air injection; do not state a fallback dissection technique without verifying the complete source.
