Name: An “All-laser” Endothelial Transplant (Video) | JoVE Journal
Uploaded: 2015-07-06T15:00:00.000+00:00
Duration: 9 min 59 s
Description: Learn an all-laser endothelial transplant technique using femtosecond laser cutting and laser welding for corneal surgery. This minimally invasive method reduces flap dislocation risk and improves donor tissue adhesion.

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5 minutes

The authors wish to thank FORTE Project, funded by Tuscany Region (POR CReO FESR 2007-2013, Bando Unico R&#38;S 2012), the EU FP7 ECHORD++ Experiment LA-ROSES that partially supported the research activities, and the FP7 BiophotonicPlus Project &#8220;LITE&#8221; granted by Tuscany Region.

The study was conducted with the prospectively approval of the hospital&#8217;s Ethics Committee; informed consent was obtained. The study was in adherence to the tenets of the Declaration of Helsinki.
1. Donor Endothelium Preparation
<ol>
	<li>Use a donor cornea as prepared by the local eye bank at room temperature.</li>
	<li>In the surgery room, pull out the donor cornea from its delivery container and set apart the solution for tissue preservation and nutrition that is used for corneal transport.</li>
	<li>Place the donor corneo-scleral rim over an artificial anterior chamber, into which a liquid can flow and create a variable pressure; cover the cornea with the tissue retaining head.</li>
	<li>Connect the artificial anterior chamber (AAC) through a 3-way connector to a syringe filled with the cornea preservation and nutrition liquid.</li>
	<li>Use the compression ring to hold the retainer securely in place.</li>
	<li>Use the syringe connected to the AAC to maintain the intracameral pressure: fill the anterior chamber with the tissue preservation solution until reaching the optimal pressure (see 1.7). Close the connector.</li>
	<li>Test the pressure inside the anterior chamber with a finger. Change the inside pressure until reaching the right internal pressure (in the range 60&#8211;70 mmHg). Close the 3-way connector.</li>
	<li>Measure the thickness of the donor cornea with Optical Coherence Thomography (OCT). Maintain the anterior chamber with that cornea in a fixed position in front of the instrument optics and then take a full thickness-OCT acquisition.</li>
</ol>
2. Femtosecond Laser Preparation of Donor Endothelium
<ol>
	<li>Perform applanation of the donor cornea under the femtosecond laser device. Use the femtosec laser to cut the donor tissue with three subsequent cuts: posterior side cut, full lamellar and anterior side cut. Set the following parameters for the three cuts.
	<ol>
		<li>For the full lamellar cut (raster pattern, start out), set the cut depth corresponding to the thinnest point of the donor cornea (measured with the OCT as described in 1.8), always subtracting 95 &#181;m. Set the pulse energy in the range 0.8-0.9 &#181;J (depending on the working depth). Set the diameter to 8.7 mm. Set the tangential spot separation to 2 &#181;m. Set the radial spot separation to 2 &#181;m.</li>
		<li>For the anterior side cut, set the posterior depth 30 &#181;m deeper than the previous full lamellar cut. Set the pulse energy to 2.10 &#181;J; the diameter to 8.6 mm; the spot separation to 3 &#181;m, while the layer separation to 3 &#181;m.</li>
		<li>For the posterior side cut, locate the anterior depth of the posterior side cut 30 &#181;m anteriorly than full lamellar cut. Set the posterior depth to 900 &#181;m. Set the pulse energy to 2.10 &#181;J; the diameter to 8.3 mm; the spot separation to 2 &#181;m; the layer separation to 2 &#181;m.</li>
	</ol>
	</li>
</ol>
3. Recipient Eye Preparation
<ol>
	<li>Prepare the patient for surgery. Make one 4.00 mm corneal incision at 12 o&#39;clock with a 4.0 mm precalibrated blade. Make one limbal paracentesis with a 1.2 mm precalibrated blade, placed at 2 o&#39;clock. Make another one limbal paracentesis at 6 o&#39;clock with a 30&#176; stab knife.</li>
	<li>Insert an anterior chamber maintainer in the patient&#8217;s anterior chamber, through the 2 o&#39;clock paracentesis.</li>
	<li>Perform one 8.2 mm diameter circular descemetorexis with the dedicated hook.</li>
	<li>Strip the Descemet membrane and endothelium from the posterior stroma and remove the tissues with a Descemet hook.</li>
</ol>
4. Chromophore Preparation
<ol>
	<li>Put 1 mg of Indocyanine Green powder in a 1.5 ml microcentrifuge tube.</li>
	<li>Add 9 mg of sterile water (the ICG water solution is 10% w/w).</li>
	<li>Manually mix the ICG powder and the water with a metal stirrer.</li>
</ol>
5. Staining of Donor Endothelium
<ol>
	<li>Put the donor endothelium onto the wider part of a Busin-injector, with the inner side in contact with the injector surface.</li>
	<li>Stain the inner side of donor endothelium with the chromophore solution, in its peripheral part, using a spatula. The correctly stained tissue has a homogeneous greenish color. Wait 3 min before starting step 5.3.</li>
	<li>Pull the donor endothelium on the anterior part of the Busin-injector, rolled.</li>
</ol>
6. Inserting the Donor Endothelium
<ol>
	<li>Grasp and insert the folded donor endothelium using an atraumatic coaxial forceps for endothelial lenticule.</li>
	<li>Remove the anterior chamber maintainer.</li>
	<li>Suture the corneal incision and the paracentesis (performed in step 3.1) with a Nylon 10.0 single stich.</li>
	<li>Inject an air bubble to unfold the donor tissue and to press it against the recipient cornea. The air bubble must completely fill the anterior chamber space.</li>
</ol>
7. Laser Welding
<ol>
	<li>Place the donor lenticule in the center of the recipient cornea, from inside with a hook or moving the air-bubble from the outside of the cornea with a spatula.</li>
	<li>Use a diode laser emitting at 810 nm, equipped with a 300 &#181;m core diameter sterile fiber optic, with 0.22 as a numerical aperture (NA).</li>
	<li>Keep the fiber tip outside the eyeball, and deliver the laser light towards the stained endothelium, through the transparent corneal tissue. The fiber tip is in non-contact configuration.</li>
	<li>Use the following settings for the laser: single spot emission mode, 70&#8211;80 msec pulse duration, 35&#8211;40 mJ per pulse. He-Ne aiming beam on.</li>
	<li>Deliver single laser spots at the stained periphery of the donor endothelium. Deliver the spots sequentially: the final aspect is a ring of spots in the periphery of the donor lenticule. The distance between two adjacent spots center is the double of a spot diameter.</li>
	<li>Apply a contact lens on the patient eye, along with 0.3% tobramycin and 0.1% dexamethasone ophthalmic suspension.</li>
</ol>

<ol><li>Tan, D. T., Dart, J. K., Holland, E. J., Kinoshita, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Corneal+transplantation%5BTitle%5D)+AND+%22Lancet%22%5BJournal%5D)">Corneal transplantation.</a> Lancet. 379 (9827), 1749-1761 (2012).</li>
<li>El Husseiny, M. A., Manero, F., Gris, O., Elies, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Historical+Review+and+Update+of+Surgical+Treatment+for+Corneal+Endothelial+Diseases%5BTitle%5D)+AND+%22Ophthalmol+Ther%22%5BJournal%5D)">Historical Review and Update of Surgical Treatment for Corneal Endothelial Diseases.</a> Ophthalmol Ther. , (2014).</li>
<li>Rossi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laser+tissue+welding+in+ophthalmic+surgery%5BTitle%5D)+AND+%22J+Biophotonics%22%5BJournal%5D)">Laser tissue welding in ophthalmic surgery.</a> J Biophotonics. 1 (4), 331-342 (2008).</li>
<li>Pini, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Combining+femtosecond+laser+ablation+and+diode+laser+welding+in+lamellar+and+endothelial+corneal+transplants%5BTitle%5D)+AND+%22Proc.+SPIE+Ophthalmic+Technologies+XVIII%22%5BJournal%5D)">Combining femtosecond laser ablation and diode laser welding in lamellar and endothelial corneal transplants.</a> Proc. SPIE Ophthalmic Technologies XVIII. 6 (844), 684411-1-684411-7 (2008).</li>
<li>Rossi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((All-laser%27+endothelial+corneal+transplant+in+human+patients%5BTitle%5D)+AND+%22Proc.+SPIE+Ophthalmic+Technologies+XXII%22%5BJournal%5D)">All-laser' endothelial corneal transplant in human patients.</a> Proc. SPIE Ophthalmic Technologies XXII. 8209, 82091O-1-82091O-3 (2012).</li>
<li>Rossi, F., Pini, R., Menabuoni, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Experimental+and+model+analysis+on+the+temperature+dynamics+during+diode+laser+welding+of+the+cornea%5BTitle%5D)+AND+%22J+Biomed+Opt%22%5BJournal%5D)">Experimental and model analysis on the temperature dynamics during diode laser welding of the cornea.</a> J Biomed Opt. 12 (1), 014031-1-014031-7 (2007).</li>
<li>Menabuoni, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laser-assisted+corneal+welding+in+cataract+surgery%3A+retrospective+study%5BTitle%5D)+AND+%22J+Cataract+Refract+Surg%22%5BJournal%5D)">Laser-assisted corneal welding in cataract surgery: retrospective study.</a> J Cataract Refract Surg. 33 (9), 1608-1612 (2007).</li>
<li>Buzzonetti, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laser+Welding+in+Penetrating+Keratoplasty+and+Cataract+Surgery+in+Pediatric+Patients.+Early+Results%5BTitle%5D)+AND+%22J+Cataract+Refract+Surg%22%5BJournal%5D)">Laser Welding in Penetrating Keratoplasty and Cataract Surgery in Pediatric Patients. Early Results.</a> J Cataract Refract Surg. 39 (12), 1829-1834 (2013).</li>
<li>Menabuoni, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+%27anvil%27+profile+in+femtosecond+laser-assistedpenetrating+keratoplasty%5BTitle%5D)+AND+%22Acta+Ophthalmol%22%5BJournal%5D)">The 'anvil' profile in femtosecond laser-assistedpenetrating keratoplasty.</a> Acta Ophthalmol. 91 (6), e494-e495 (2013).</li>
<li>Canovetti, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laser-assisted+penetrating+keratoplasty%3A+one+year%E2%80%99s+results+in+patients%2C+using+a+laser-welded+%E2%80%9Canvil%E2%80%9D-profiled+graft%5BTitle%5D)+AND+%22Am+J+Ophthalmol%22%5BJournal%5D)">Laser-assisted penetrating keratoplasty: one year’s results in patients, using a laser-welded “anvil”-profiled graft.</a> Am J Ophthalmol. 158 (4), 664-670 (2014).</li>
</ol>

The authors declare that they have no competing financial interests.

The &#8220;all laser&#8221; endothelial transplant is an original approach to minimally invasive corneal transplantation.
All the procedures described within the protocol were performed in the surgery room, observing the hygienic and sterilization procedure that are common practices during surgeries, such as the use of sterilized gloves, gown, mask and cap. The ICG solution was prepared in the surgery room, soon before its application in staining the donor endothelium. The ICG powder, the wate...

In this work we present an original approach to endothelial keratoplasty, based on the use of a femtosecond laser to prepare donor tissue and a near infrared diode laser to weld it onto the recipient bed. Intraoperative measurement of the donor cornea is necessary to correctly design the donor tissue dimensions. Endothelial keratoplasty has been proposed in the recent years to replace penetrating keratoplasty in treating endothelial disease1,2. The main advantage of this technique is a faster visual recovery, with respect to penetrating keratoplasty, reduced anesthesia during surgery, a decreased risk of graft rejection and the preservation of eye integrity. The main risk factor is postoperative donor lenticule dislocation. The standard technique is performed by inserting the donor endothelium in its final position where it is maintained by the injection of an air bubble: no sutures are used because of the mechanical, biophysical and dimensional characteristics of the endothelium. Moreover, visual acuity recovery can be limited mainly because of a mismatch between donor and recipient tissues due to a thick tissue transplanted.
Here we present a procedure in performing endothelial keratoplasty that can overcome those main problems. The donor endothelium can be assured in its final position by the use of the laser welding technique. This is a controlled and localized photothermal process: it can be induced at the donor/recipient interface. It has been studied in the last ten years and proposed in penetrating keratoplasty and in the transplant of endothelium3-5. The near infrared light (wavelength: 810 nm) emitted by a low power diode laser is delivered towards the biological tissue at the wound site. The cornea is naturally transparent to this wavelength: in order to make this tissue to absorb the laser light, it is necessary to stain it with a chromophore. The proposed dye is a sterile saturated water solution of Indocyanine Green (ICG). We demonstrated that when corneal tissue is properly stained with this ICG preparation, it shows an absorption peak at 810 nm6. Moreover, ICG is widely used in clinical diagnostics and its safety has been already demonstrated in human subjects. The stained cornea absorbs the diode laser light energy and the main resulting effect is a controlled temperature rise at the welding site. No thermal effects are induced in the unstained tissues. The temperature enhancement induces reversible thermal denaturation in the stromal collagen, with an immediate closuring of the wound walls upon cooling. This laser welding effect was firstly demonstrated in cataract surgery7,8 and penetrating keratoplasty9,10. An optimized approach that we are presenting in this paper has been studied for application in endothelial keratoplasty.
In the proposed surgery, single laser spots (lasting tens of msec) are delivered to the tissue, resulting in a photothermal effect localized within the spot dimension (a few hundreds of &#181;m in diameter): the induced effect is a hard laser welding, consisting of a photocoagulation of the collagen confined at the donor/host interface. The result of the collagen denaturation at the welded site is a strong adhesion between the donor and host tissues, thus providing a suturing effect that is impossible to obtain with standard technique (stitches). The tissue regains his natural appearance in a short follow up (1 month) and the adhesion between donor/host tissues is improved by the welding provided in the very early stage of the healing phase.
To avoid the other main risk of the endothelial keratoplasty, i.e. the transplant of a thick donor tissue, intrasurgical optical coherence tomography (OCT) is used: a commercial device measures the thickness of donor cornea, so that a correct cut profile can be designed with the femtosec laser. The proposed &#8220;all laser&#8221; endothelial transplant thus seems to improve the clinical results of this minimally invasive surgery.

<table><tbody><tr><td>Indocyanine Green</td><td>Pulsion Medical Systems, Germany</td><td>ICG-PULSION (http://www.pulsion.com/international-english/perfusion/icg-pulsion/)</td><td>Alternative product: IC-GREEN, Akorn&amp;nbsp; Inc., Lake Forest, Illinois- US (http://www.icginjection.com/)</td></tr><tr><td>Femtosecond Laser&amp;nbsp;</td><td>Abbott Medical Optics,&amp;nbsp; Abbott Laboratories Inc. Abbott Park, Illinois, USA</td><td>iFS150 (http://www.abbottmedicaloptics.com/products/refractive/ilasik/ifs-advanced-femtosecond-laser)</td><td></td></tr><tr><td>Optical Coherence Tomography (OCT)</td><td>Carl-Zeiss Meditec, Dublin, California- US (http://www.zeiss.com/meditec/en_de/home.html)</td><td>Visante</td><td></td></tr><tr><td>Diode Laser</td><td>E.l.En. Group s.pa., Calenzano-FI, Italy (http://www.elengroup.com/en/divisions/medical)</td><td>Mod. WELD 800</td><td></td></tr><tr><td>Artificial Anterior Chamber</td><td>CORONET, corneal graft products. Network Medical Products Ltd. Coronet House, Kearsley Road, Ripon, North Yorkshire, HG4 2SG, UK</td><td>Artificial Anterior Chamber (A.A.C.) with large and small tissue-retaining heads. Code 51-935 (http://www.networkmedical.co.uk/ophthalmic_artificial_&lt;br /&gt;anterior_chamber.html)</td><td></td></tr><tr><td>Solution for tissue preservation and nutrition&amp;nbsp;&amp;nbsp;</td><td>AL.CHI.MI.A. Srl, Viale Austria 14, 35020 - Ponte S. Nicol&amp;ograve; - PD&lt;br/&gt; &amp;nbsp;ITALY</td><td>Carry-C media for corneal deturgescence and transport at room temperature - 12 x 50 ml (http://www.alchimiasrl.com/en/organ-culture-at-31&amp;deg;-c-eb/carry-c-eb)</td><td></td></tr></tbody></table>

an &#8220;all-laser&#8221; endothelial transplant

An &#8220;All-laser&#8221; Endothelial Transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

The “all laser” surgical procedure is proposed to perform minimally invasive corneal transplantation. The procedure is easy to perform (see Figure 1): 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 an increased surgical time of a few min. The use of intraoperative OCT to measure the donor cornea thickness and the femtosecond laser used to cus...

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

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.

Research

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Medicine

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Learn an all-laser endothelial transplant technique using femtosecond laser cutting and laser welding for corneal surgery. This minimally invasive method reduces flap dislocation risk and improves donor tissue adhesion.

An “All-laser” Endothelial Transplant

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