Intrastromal lamellar femtosecond laser keratoplasty with superficial flap

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Abstract
Using a corneal contact lens and a femtosecond laser (20/10 Perfect Vision, Am Taubenfeld 21/1, D-69123 Heidelberg, Germany) with a wavelength of 1060 nm, a spot size of about 10 μm, and a laser pulse duration of several hundred femtoseconds, a pre-descemetal incision running parallel to the corneal surface was created in five postmortem eyes of slaughterhouse pigs. The diameter of the deep stromal incision was 7 mm. In a second step, a circular sagittal incision was performed starting from the peripheral edge of the already existing incision in the pre-descemetal level to the superficial layer of the corneal stroma. In continuation of the latter sagittal incision, a corneal flap was prepared with a diameter of 7 mm, a thickness of about 100 μm, a hinge, and three positional pikes.4 The pikes in the flap with the corresponding notches in the bed of the flap were formed to increase the rotational stability of the flap after repositioning. The height of the peaks was about 0.40 mm. After opening of the flap the intrastromal segment situated between the pre-descemetal incision and the incision in the superficial stromal level was removed and exchanged against a similar formed segment obtained from another (donor) pig eye. In a final step, the flap was repositioned.