1. Descemet-Stripping Automated Endothelial Keratoplasty Grafts Prepared from Endothelial Side Using a 500 kHz Femtosecond Laser: Six-Month Outcomes Jesper Hjortdal, Anders Ivarsen, Kim Nielsen Department of Ophthalmology, Aarhus University Hospital, Denmark The authors have no financial interest in the subject matter of this poster

2. Problem DSAEK grafts are usually cut by a micro-keratome or a femtosecond laser after the epithelial side of the donor cornea has been applanated This approach result in – variable central graft thickness in different grafts – an increase in graft thickness towards the periphery in every graft Donor cornea with epithelial side up Applanated cornea during cutting Resulting DSAEK graft of non-uniform thickness

3. New approach If DSAEK grafts can be prepared from the endothelial side by a femtosecond laser, reproducible, thin grafts of even thickness can be produced Donor cornea with endothelial side up Cutting using FS-laser with concave applicator Resulting DSAEK graft of uniform thickness Concave applicator of the Visumax femtosecond laser Concave applicator of the Visumax femtosecond laser

4. Graft Preparation Zeiss-Meditec Visumax 500 kHz FS laser 7.5 mm diameter 130  m thickness #1 FS-laser cutting of DSAEK graft #2 Breaking remaining tissue bridges

5. Patients & Surgery 10 patients with Fuchs endothelial dystrophy Age range: 54 to 78 years of age 5 patients had also phaco + PCIOL Standard DSAEK with Busin glide + forceps #3 DSAEK graft in Busin glide

6. Results – First week Rebubbling necessary in 5 of 10 cases (normally only in 1 of 10 cases) All grafts were attached and clearing up after one week 3 months after implantation of a DSAEK graft prepared from endothelial side

7. Results – Visual Acuity (4-6 months) (Decimal units) Average: 0.30 Range: 0.16 to 0.50 Note shadows in red reflex due to interface haze 3 months after implantation of a DSAEK graft prepared from endothelial side

8. Corneal Thickness (4-6 months) Average: 0.58 mm Range: 0.51 to 0.63 mm DSAEK graft prepared with Moria ALK keratome (for comparison) (Pentacam HR) DSAEK graft prepared with Visumax FS-laser from endothelial side (Pentacam HR) Note uniform thickness, but interface haze of FS-laser prepared graft

9. Endothelial Cell Count (4-6 months) Average: 1.570 /mm 2 Range: 1.400 to 2.000 /mm 2

10. Scanning Electron Microscopy FS-Laser Moria ALK Note laser spots in FS-laser prepared graft

11. Conclusions DSAEK grafts can be prepared from endothelial side using a femtosecond laser 10 of 10 grafts clear after 4-6 months Satisfying endothelial cell count Poor visual acuity due to scatter in interface from laser spots FS-Laser settings need to be fine-tuned Acknowledgement: Jacques Chevallier, Dept. of Physics and Astronomy, Univ. of Aarhus for SEM imaging