A New Surgical Technique: A Femtosecond Laser-Assisted Keratolimbal Allograft Procedure

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Purpose:To evaluate the feasibility of a femtosecond (FS) laser-assisted keratolimbal allograft (KLAL) technique.Design:Interventional case series.Methods:This study included 3 patients with extensive limbal stem cell deficiency. The donor cornea was dissected with an FS laser (IntraLase FS laser, 60 kHz) using a ring procedure, without outer side cutting for the limbal graft, after a penetrated dissection of the donor cornea prior to penetrating keratoplasty (PKP). The depth and width of the ring procedure were adjusted for each individual patient. Further extension to the periphery of the sclerocorneal tissue of the donor graft was performed with a diamond knife. In a case of KLAL alone, the unhealthy limbal tissue of the recipient was removed with the FS laser by the same method employed in donor preparation. One patient underwent KLAL alone, and 2 patients underwent KLAL combined with PKP. The patients were followed up for a maximum of 10 months.Results:Limbal grafts were even and thin, as expected. The case with KLAL alone showed the fastest epithelization of the recipient cornea. The 2 cases of combined KLAL and PKP showed excellent approximation between recipient and donor tissue. The ocular surfaces have been stable for 8 months in case 1 and 10 months in cases 2 and 3.Conclusion:FS laser-assisted KLAL has potential advantages in terms of simplicity and speed as compared with conventional techniques.

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