Femtosecond Laser-Assisted Deep Lamellar Descemet Membrane Endothelial Keratoplasty for the Treatment of Endothelial Dysfunction Associated With Posterior Stromal Scarring

Purpose: To describe an alternative surgical approach, femtosecond laser-assisted deep lamellar Descemet membrane endothelial keratoplasty (Femto-DL-DMEK), for the treatment of corneal endothelial diseases associated with posterior stromal scarring. Methods: Case report of a 52-year-old man with pseudophakic bullous keratopathy and posterior corneal scarring secondary to viral endotheliitis who underwent Femto-DL-DMEK. The surgical technique was as follows: First, a manual lamellar dissection plane was created at approximately 75% to 85% depth through a 5.0-mm superior scleral incision. One week later, using a femtosecond laser, an intersecting posterior side cut of 8.2 mm diameter was created. Subsequently, the dissected posterior recipient disk was removed from the anterior chamber through a 3.2-mm limbal incision. Finally, an 8.0-mm DMEK graft was placed. Results: The patient's uncorrected distance visual acuity improved from 20/200 (0.15; decimal) preoperatively to 15/25 (0.6) after surgery; corrected distance visual acuity improved from 20/200 (0.15) to 20/25 (0.9) with a residual refraction of +1.0–0.50 at 140 degrees. Endothelial cell count was 2062 cell/mm2 6 months after surgery. No intra- or postoperative complications were noted. Conclusions: As long as the anterior and mid-stroma are unaffected, those with endothelial diseases associated with opacification of the posterior stroma can benefit from endothelial keratoplasty through a Femto-DL-DMEK procedure, avoiding all well-known drawbacks of penetrating keratoplasty.