Excimer laser-assisted lamellar endothelial keratoplasty (ExALEK): Technique and results

Introduction. - The purpose of this study is to describe a technique for thin endothelial lamellar keratoplasty and to present the results for endothelial transplant performed at the University Hospital of Nantes. Materials and methods. This paper is a retrospective, single-center descriptive study conducted at the University Hospital of Nantes from September 2010 to May 2014, at first for anatomical or analgesic indications (group 1) and then extended to visual indications (group 2). Patients were followed for 12 months. The preparation of the endothelial graft includes an excimerlaser ablation of the residual stromal bed after lamellar keratectomy by manual deep anterior approach. Results. - Seventy surgeries were analyzed. The etiologies were mainly Fuchs Dystrophy, secondary endothelial dystrophy and post-penetrating keratoplasty endothelial failure. Fifty-three patients were integrated in group 1 and seventeen patients in group 2. In group 1, the mean VA at 12 months was 0.70 0.30 LogMAR (0.2 decimal equivalent). In group 2, the mean VA at 12 months was 0.28 +/- 0.12 LogMAR (0.5 decimal equivalent). Pachymetry decreased from 740 +/- 125.1 mu m preoperatively to 613.4 +/- 73.4 mu m at 12 months. The average central thickness of the graft was 84.1 +/- 28.9 vim at 1 month and 80.2 +/- 29.4 vim at 12 months. Conclusion.- The advantage of this new surgical technique is that it is a rapid and repeatable method allowing thin grafts with satisfactory functionality and easy handling. Its performance independent of the scheduled surgery, allows for predictable organization in the operating room. (C) 2015 Elsevier Masson SAS. All rights reserved.