On the Possibility of Femto-DALK Performing in Open Globe Eye Injury with Corneal Localisation

Purpose: to evaluate the feasibility of femtosecond-assisted deep anterior lamellar keratoplasty (DALK) for corneal open eye injury (OEI), to describe its technical features and to present postoperative outcomes.

Patients and methods. Femto-DALK was performed in 6 male patients (6 eyes) aged 27.13 ± 5.17 years with corneal scars, the outcomes of combat-related ocular trauma with corneal localization (zone I). Endothelial cell calculation, keratotopography, optical coherence tomography (OCT) of the eye anterior segment, and electrophysiological studies were performed. The surgeries were provided on the Femto-LDV Z8 (Ziemer, Switzerland) using non-standard laser parameters. In the postoperative period, the data of visometry, biomicroscopy, and OCT of the anterior segment were assessed. The observation period was 12.1 ± 1.1 months.

Results. In all cases, the corneal interface was formed. Further exposure of the Descemet membrane (DM) was carried out in two ways: in 3 cases it was possible to form a “Big bubble” (50 %), and in 3 cases this technique did not produce results, and the removal of deep layers of the stroma was carried out manually. During manual stroma dissection, macroperforation of the Descemet membrane (DM) occurred in 16.7 % of cases, which required conversion to penetrating keratoplasty. During the formation of the “Big Bubble”, microperforation also occurred in 1 case (16.7 %), which allowed completing the anterior lamellar deep keratoplasty. Intraoperative detachment of the DM was observed in 1 case (16.7 %). In the postoperative period, corneal graft failure was not detected in any case, by the 12-th month, the thickness of the central cornea was 480 ± 50 µm. Best corrected visual acuity increased to 0.3 ± 0.2 by the first month after the surgery and to 0.4 ± 0.2 by the end of the first year of observation.

Conclusions. Femto-DALK in corneal OEI allows achieving good anatomical and functional results. The features of the femto-DALK technique in corneal OEI are high laser radiation power and reduced femto-laser speed. The presence of scars in recipient’s stroma does not exclude the impossibility of implementing the “Big bubble” technique, but in half of the cases it is necessary to switch to manual detachment and removal of residual stroma. Conversion to penetrating keratoplasty is also possible.

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