Titiyal Jeewan S, Aravind M J, Kaur Manpreet, Nag Tapas C, Sharma Namrata, Agarwal Tushar, Sinha Rajesh
Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2020 Nov;68(11):2404-2407. doi: 10.4103/ijo.IJO_99_20.
To compare surface quality and endothelial cell viability of descemet stripping automated endothelial keratoplasty (DSAEK) donor lenticules prepared with femtosecond laser (FSL) or microkeratome (MK).
Experimental ex-vivo evaluation of 15 DSAEK donor lenticules prepared from optical quality donor corneas using 200 KHz FSL (9 eyes) or MK (6 eyes). Surface quality and smoothness of the cut were assessed using atomic force microscopy and endothelial cell viability was assessed using transmission electron microscopy.
Mean lenticule thickness was 121.89 ± 17.13 μm in FSL group and 112.67 ± 5.89 μm in MK group (P = 0.33). Average roughness of stromal surface (RMSavg) [FSL- 30.51 ± 4.55 nm, MK-22.37 ± 1.83 nm; P = 0.02] and root mean square roughness (RMSrough) [FSL-31.39 ± 5.75 nm, MK-23.08 ± 0.40 nm; P = 0.012] was significantly more in FSL group. Increased granular and linear irregularities were observed in the FSL group. Endothelial cell disruption was more in FSL group (FSL- 29.49 ± 6.91% MK-13.28 ± 3.62%; P < 0.001) with decreased mean nucleus length (FSL-5.56 ± 0.17 μm, MK-7.52 ± 0.65 μm; P < 0.001).
Automated MKs are still the standard of care for donor lenticule preparation and MK-assisted donor lenticules have smoother surface with less endothelial cell disruption than FSL. Further research is mandatory before FSL platforms can be considered a viable alternative to the MK.
比较使用飞秒激光（FSL）或微型角膜刀（MK）制备的深板层角膜内皮移植术（DSAEK）供体植片的表面质量和内皮细胞活力。
对15个由光学质量供体角膜制备的DSAEK供体植片进行实验性离体评估，其中9眼使用200 KHz飞秒激光（FSL），6眼使用微型角膜刀（MK）。使用原子力显微镜评估切口的表面质量和平滑度，使用透射电子显微镜评估内皮细胞活力。
FSL组植片平均厚度为121.89±17.13μm，MK组为112.67±5.89μm（P = 0.33）。FSL组基质表面的平均粗糙度（RMSavg）[FSL-30.51±4.55nm，MK-22.37±1.83nm；P = 0.02]和均方根粗糙度（RMSrough）[FSL-31.39±5.75nm，MK-23.08±0.40nm；P = 0.012]明显更高。FSL组观察到颗粒状和线性不规则性增加。FSL组的内皮细胞破坏更多（FSL-29.49±6.91%，MK-13.28±3.62%；P < 0.001），平均细胞核长度减少（FSL-5.56±0.17μm，MK-7.52±0.65μm；P < 0.001）。
自动微型角膜刀仍是供体植片制备的标准方法，与飞秒激光相比，微型角膜刀辅助制备的供体植片表面更光滑，内皮细胞破坏更少。在飞秒激光平台被认为是微型角膜刀的可行替代方案之前，必须进行进一步的研究。
