An “All-laser” Endothelial Transplant

The overall goal of this procedure is to perform an all laser, minimally invasive surgery for the transplant of thin corneal ententes. This is accomplished by first measuring the donor cornea and cutting it with a Femto second laser. Next incisions are made in the recipient's corneal bed and the desme membrane and endothelium are removed in preparation for the donor tissue.

Then the donor flap is stained and inserted in its final position. Finally, the donor lent acue is laser welded to the recipient cornea. Ultimately, donor endothelium adhesion can be seen one day after surgery.

The main improvement of this technique over existing method like standard is that with laser wielding flap dislocation risk is reduced after surgery. The Implications of this technique extend toward the surgery of corneal transplant because the application of laser welding procedure has been studied also in neurosurgery and ENT. Generally, people new To this method will not struggle because it's very easy to perform.

To begin in the surgery room, remove the donor cornea from its delivery container at room temperature and set aside the corneal transport solution. Connect the artificial anterior chamber or a a C through a three-way connector to a syringe filled with cornea preservation and nutrition.Liquid. Place the donor corneal scleral rim over an artificial chamber into which a liquid can flow and create variable pressure.

Then with the tissue retaining head cover the cornea. Then use a compression ring to hold the retainer securely in place. Next, with the syringe connected to the A A C, to maintain the intracameral pressure, use tissue preservation solution to fill the anterior chamber until reaching the optimal pressure.

Then close the three-way connector using a finger. Test the pressure inside the anterior chamber, adjusting it until the correct internal pressure is reached. To measure the thickness of the donor cornea, maintain the anterior chamber with a cornea in a fixed position and with optical coherence tomography or OCT.

Take a full thickness OCT measurement to cut the donor tissue After its app explanation, begin with a full lam or cut by setting the cut depth corresponding to the thinnest point of the donor cornea minus 95 microns. Set the pulse energy in the range of 0.8 to 0.9 micro joules. Set the diameter to 8.7 millimeters.

Set the tangential spot separation to two micrometers, and set the radial spot separation to two micrometers where the anterior side cut. Set the posterior depth, 30 micrometers deeper than the previous full lamire.Cut. Set the pulse energy to 2.10 micro joules, the diameter to 8.6 millimeters for the posterior side.Cut.

Locate the anterior depth of the posterior side and cut 30 micrometers anteriorly to the full lam or cut. Set the posterior depth to 900 micrometers. Set the pulse energy to 2.10 micro joules.

The diameter to 8.3 millimeters, the spot separation to two micrometers and the layer separation to two micrometers. Then make the cut to prepare the patient for surgery with a 1.2 millimeter pre calibrated blade. Make a limbal paracentesis at two o'clock through the two o'clock paracentesis.

Insert an anterior chamber maintainer in the patient's anterior chamber. Then using a 30 degree stab knife. Make a second limbal paracentesis at six o'clock.

Use a 2.0 millimeter pre calibrated blade to make a 2.00 corneal incision at 12 o'clock. Then with a dedicated hook, perform one 8.2 millimeter diameter circular desme or axis. Strip the desme membrane and endothelium from the posterior stroma and use a desme hook to remove the tissues.

To prepare the chromophore for staining the donor tissue, add one milligram of indocyanine green or ICG powder to a 1.5 milliliter micro centrifuge tube. Then add nine milligrams of sterile water with a metal stirrer. Manually mix the ICG solution to suspend the powder.

Place the donor endothelium onto the wider portion of a abuse and injector with the inner side in contact with the injector surface. Using a spatula add chromo four solution to the inner side of the donor endothelium to stain it a homogeneous green color. After waiting three minutes, roll the endothelium and insert it into the anterior part of the busin injector.

Using an atraumatic coaxial forceps, grab and insert the folded donor endothelium with a single 10.0 nylon stitch. Suture the corneal incision and the paracentesis. Inject an air bubble completely filling the anterior chamber space to unfold the donor tissue and press it against the recipient cornea.

Then remove the anterior chamber maintainer from inside with a hook or by using a spatula to move the air bubble from the outside. Place the donor lenti in the center of the recipient cornea. Set a DDE laser emitting at 810 nanometers with a 300 micrometer core diameter, sterile fiber optic, and a 0.22 numerical aperture using the settings listed here for the laser and while keeping the fiber optic outside the eyeball and in non-contact configuration sequentially, deliver single laser spots along the periphery of the stained endothelium through the transparent corneal tissue.

The final aspect is a ring of spots in the periphery of the donor lenti. The distance between the centers of two adjacent spots is the double of a spot diameter. When the laser welding is complete, apply 0.3%tobramycin and 0.1%dexamethasone ophthalmic suspension to the patient eye.

Then apply a contact lens. This all laser surgical procedure performs a minimally invasive corneal transplantation with respect to a standard endothelial transplant. Only the steps of measuring the corneal thickness staining the donor tissue and delivering the laser light are added.

The achieved advantages largely compensate for an increased surgical time of a few minutes. The use of intraoperative OCT to measure the donor cornea thickness and the femtosecond laser used to customize the donor lenticule dimensions enables the improvement of the donor host interface adhesion compared to not performing the donor cornea thickness measurement as shown here, which results in poor adhesion at the periphery. In doing so, the surgery is designed following the needs and morphological characteristics of the individual patient.

In a standard technique, it is not possible to suture the donor tissue in any way because of its biomechanical characteristics and location. However, the laser welding procedure delivers a complete ring of spots covering the external diameter of the donor recipient interface, and provides an immediate closure of the interface. One day after surgery, a partially welded endothelium shows donor occu dislocation except at weld sites.

Following this procedure, other methods like anterior ular otoplasty can be performed in order to additional question like how to avoid the use of standard suing After its development. This technique paved the way for researchers in the microsurgery field to explore suturing in thin tissues, inaccessible sites, such as in end-to-end anastomosis in brain surgery. After watching this video, you Should have a good idea of how to perform endothelial ker otoplasty with a low risk of linical displacement after surgery.

This matter provide us very thin linical that adheres to recipient med with a good satisfaction of our patient.