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Exploring the precision of femtosecond laser-assisted descemetorhexis in Descemet membrane endothelial keratoplasty
  1. Daniel Pilger,
  2. Christoph von Sonnleithner,
  3. Eckart Bertelmann,
  4. Anna-Karina B Maier,
  5. Antonia M Joussen,
  6. Necip Torun
  1. Department of Ophthalmology, Charité-Medical University Berlin, Berlin, Germany
  1. Correspondence to Dr Daniel Pilger; daniel.pilger{at}


Objective Descemet membrane endothelial keratoplasty (DMEK) remains a challenging technique. We compare the precision of femtosecond laser-assisted DMEK to manual DMEK.

Methods and Analysis A manual descemetorhexis (DR) of 8 mm diameter was compared with a femtosecond laser-assisted DR of the same diameter (femto-DR) in 22 pseudophakic patients requiring DMEK. We used OCT images with a centred xy-diagram to measure the postoperative precision of the DR and the amount of endothelial denuded area. Endothelial cell loss (ECL) and best corrected visual acuity were measured 3 months after surgery.

Results In the manual group, the median error of the DR was 7% (range 3%–16%) in the x-diameter and 8% (range 2%–17%) in the y-diameter. In the femto group, the median error in the respective x and y-diameters was 1% (range 0.4%–3%) and 1% (range 0.006%–2.5%), smaller than in the manual group (p=0.001). Endothelial denuded areas were larger in the manual group (11.6 mm2, range 7.6–18 mm2) than in the femto group (2.5 mm2, range 1.2–5.9 mm2) (p<0.001). The ECL was 21% (range 5%–78%) in the manual DR and 17% (range 6%–38%) in the femto-DR group (p=0.351). The median visual acuity increased from 0.4 logMAR (range 0.6–0.4 logMAR) in both groups to 0.1 logMAR (range 0.4–0 logMAR) in the manual group and to 0.1 logMAR (range 0.3–0 logMAR) in the femto group (p=0.461). Three rebubblings were required in the manual group, whereas the femto group required only one.

Conclusion The higher precision of the femto-DR bears the potential to improve DMEK surgery.

  • cornea
  • treatment surgery

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  • DP and CvS contributed equally.

  • Contributors DP and CvS conducted the study, performed the analysis and wrote the first draft of the manuscript. EB, AKBM and AMJ contributed to the analysis and interpretation of the findings and added to the writing of the manuscript. NT conceived the study, performed the surgeries, interpreted the findings and contributed to the writing of the final manuscript. DP, CvS and NT act as guarantors for the overall content of this work.

  • Funding Consumables for the LenSx femtosecond laser were provided free of charge by Alcon Laboratories (Fort Worth, Texas, USA).

  • Competing interests DP and NT received financial support from Alcon Laboratories for presentations at meetings.

  • Patient consent for publication Not required.

  • Ethics approval Charite Universitätsmedizin Ethikkommission.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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