Femtosecond laser-assisted keratoplasty: Full and partial-thickness cut wound strength and endothelial cell loss across a variety of wound patterns

Kamden R. Kopani, Michael A. Page, Jeff Holiman, Armando Parodi, Bernie Iliakis, Winston Chamberlain

Research output: Contribution to journalArticle

10 Scopus citations


Purpose: To evaluate wound strength for patient safety during transport and endothelial viability when partial and complete femtosecond laser-assisted keratoplasty (FLAK) incisions are made in cadaveric corneas. Methods: 19 human corneoscleral rims were divided into six groups, mounted on an anterior chamber maintainer and cut with a femtosecond laser programmed to the following patterns: 'zigzag ' (A), 'mushroom' (B) and 'top hat' (C) in both full (1) and partial (2) thicknesses. The pressure required to produce leakage from the corneal incision was then measured. Eight additional corneas were cut with the 'zigzag' pattern: four full and four partial thickness, prepared and transported per standard eye bank protocol, and analysed for endothelial cell loss with trypan blue staining and digital image analysis. Results: Mean leakage pressure in mm Hg for group A1 was 110 (SD 94); group A2, 1180 (SD 468); group B1, 978 (SD 445); group B2, 987 (SD 576); group C1, 710 (SD 474); group C2, 1290 (SD 231). There was a significant difference in leakage pressure between groups A1 and A2 ( p=0.05), groups A1 and B1 ( p=0.05), and groups A1 and C1 ( p=0.05). Mean percentage endothelial damage after full-thickness cuts was 8.40 (SD 2.34) and 5.30 (SD 1.33) in partial-thickness cuts ( p=0.11). Conclusions: Partial thickness zigzag, top hat and mushroom-style partial FLAK incisions left an intact tissue wall with high resistance to rupture, whereas full-thickness cuts were more variable. Laser trephination and eye bank handling protocol for donor FLAK buttons leads to moderate peripheral endothelial cell loss in tissue with both complete and partial cuts.

Original languageEnglish (US)
Pages (from-to)894-899
Number of pages6
JournalBritish Journal of Ophthalmology
Issue number7
StatePublished - Jul 2014


ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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