FEMTOSECOND LASER-ASSISTED KERATOPLASTY: WOUND INTEGRITY IN EYE BANK EYES João Baptista Malta, MD, H. Kaz Soong, MD, Roni Shtein, MD, Michael Banitt, MHA,

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FEMTOSECOND LASER-ASSISTED KERATOPLASTY: WOUND INTEGRITY IN EYE BANK EYES João Baptista Malta, MD, H. Kaz Soong, MD, Roni Shtein, MD, Michael Banitt, MHA, MD, David C. Musch, PhD, MPH, Alan Sugar, MD, and Shahzad I. Mian, MD Financial interest disclosure: None for all authors DEPARTMENT OF OPHTHALMOLOGY AND VISUAL SCIENCES W.K. KELLOGG EYE CENTER UNIVERSITY OF MICHICAN

PURPOSE To optimize the surgical technique for performing Femtosecond Laser-Assisted Keratoplasty (FLAK) to cut both recipient and donor corneal buttons using the IntraLase FS ® To test the stability and integrity of the incisions closed with different methods

METHODS FLAK performed in 6 human globes and 6 corneoscleral buttons for each of the following trephination patterns –Top hat –Mushroom –Tongue-groove –Vertical Manual trephination as control

Cross-sectional schematic diagram of laser cuts and measurements in mushroom pattern

METHODS Incision closure with –8 sutures –8 sutures with fibrin adhesive –16 sutures Wound integrity measured with intraocular pressure required to produce graft-host wound leakage (IOP L ) and dehiscence

RESULTS Mushroom and top hat FLAK had significantly higher IOP L than vertical or manual trephination (p<0.001) for wounds closed with 16 sutures. There was no difference in IOP L between top hat, mushroom, and tongue-groove FLAK in wounds closed with 8 sutures with fibrin adhesive (p>0.75).

Mean intraocular pressure leakage (IOP L ) (mm Hg) of keratoplasty procedure comparing suture technique

Mean intraocular pressure leakage (IOP L ) (mm Hg) of suture technique comparing keratoplasty procedure

CONCLUSION These preliminary studies show that FLAK produces precise trephination cuts of superior wound strength and stability to that of manual trephination. Adjuvant fibrin glue may further improve wound integrity.

REFERENCES Steinert RF, Ignacio TS, Sarayba MA. "Top hat"- shaped penetrating keratoplasty using the femtosecond laser. Am J Ophthalmol 2007;143: Bahar I, Kaiserman I, Slomovic A, McAllum P, Rootman D. Fibrin glue for opposing wound edges in "Top Hat" penetrating keratoplasty: a laboratory study. Cornea 2007;26: Ignacio TS, Nguyen TB, Chuck RS, Kurtz RM, Sarayba MA. Top hat wound configuration for penetrating keratoplasty using the femtosecond laser: a laboratory model. Cornea 2006;25: