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 - Takeaways - MDSpire
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Clinical Outcomes of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty: An iOCT-Guided Pre-Descemet Tunnel Case Series of 42 Eyes

  • By

  • Nicola R. Otto

  • Friedrich A. Steindor

  • Gerd Geerling

  • Theo G. Seiler

  • October 14, 2026

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  • 1

    This retrospective single-center case series evaluated iOCT-guided femtosecond laser-assisted DALK in 42 eyes treated from January 2020 through December 2023.

  • 2

    The laser created a pre-Descemet intrastromal tunnel planned approximately 30 μm anterior to Descemet membrane for air injection and pneumatic dissection.

  • 3

    All procedures were performed under general anesthesia by a single surgeon using the Ziemer LDV Z8 femtosecond laser.

  • 4

    The study recorded big-bubble formation, Descemet membrane perforation, conversion to penetrating keratoplasty, surgical duration, and postoperative outcomes.

  • 5

    When big-bubble formation failed after up to five attempts, the surgeon proceeded with manual stromal dissection using a spiral-down technique.

Original Source(s)

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

  • by Nicola R. Otto, Friedrich A. Steindor, Gerd Geerling, Theo G. Seiler

  • October 14, 2026

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