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Peer-reviewedCC BYBMC ophthalmology

Success of femtosecond laser-assisted deep anterior lamellar keratoplasty (Femto-DALK): a clinical case series of 42 eyes using an intraoperative optical coherence tomography (iOCT)-guided laser-generated pre-descemet tunnel.

  • Nicola R Otto1
  • Friedrich A Steindor2
  • Gerd Geerling2
  • Theo G Seiler2,3,4
4 affiliations
  1. 1Department of Ophthalmology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany. [email protected].
  2. 2Department of Ophthalmology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
  3. 3Institut für Refraktive and Ophthalmo-Chirurgie (IROC), Stockerstr. 37, Zürich, 8002, Switzerland.
  4. 4Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, 3010, Switzerland.
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Abstract

Purpose

To evaluate the success of Femto-DALK with an iOCT-guided generated intrastromal pre-Descemet tunnel.Methods

This monocentric, retrospective study evaluated all patients treated with Femto-DALK between January 2020 and December 2023 at the Department of Ophthalmology at the University of Düsseldorf (Germany). The iOCT-guided tunnel was generated 30 microns anterior of Descemet's membrane. BB generation, surgery time and conversion to penetrating keratoplasty (PK) were analyzed.Results

A total of 42 eyes of 41 patients were identified. BB creation was successful in 78.6% of cases. Intraoperative conversion to PK was necessary in 28.6% of the eyes and microperforation of Descemet's membrane (DM) occurred in 16.7% of completed DALKs. Mean operation time was 118.6 ± 40.68 min. Among successful Femto-DALKs (n = 30), double anterior chamber was observed in 26.7%, and re-bubbling was needed in 23.3%. Re-keratoplasty was performed in one eye (3.3%).Conclusion

Femto-DALK with an iOCT-guided pre-Descemet tunnel generation is a feasible technique that achieves BB success rates comparable to the upper range reported for manual dissection, without a clear demonstrated improvement over manual technique.

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Cite

BibTeXRIS
BibTeX
@article{otto2026success,
  title = {{Success of femtosecond laser-assisted deep anterior lamellar keratoplasty (Femto-DALK): a clinical case series of 42 eyes using an intraoperative optical coherence tomography (iOCT)-guided laser-generated pre-descemet tunnel.}},
  author = {Nicola R Otto and Friedrich A Steindor and Gerd Geerling and Theo G Seiler},
  journal = {BMC ophthalmology},
  year = {2026},
  month = oct,
  doi = {10.1186/s12886-026-05416-1},
  url = {https://europepmc.org/article/MED/42875753},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Success of femtosecond laser-assisted deep anterior lamellar keratoplasty (Femto-DALK): a clinical case series of 42 eyes using an intraoperative optical coherence tomography (iOCT)-guided laser-generated pre-descemet tunnel.
AU  - Nicola R Otto
AU  - Friedrich A Steindor
AU  - Gerd Geerling
AU  - Theo G Seiler
PY  - 2026
DA  - 2026/10/14
JO  - BMC ophthalmology
DO  - 10.1186/s12886-026-05416-1
UR  - https://europepmc.org/article/MED/42875753
AB  - Purpose  To evaluate the success of Femto-DALK with an iOCT-guided generated intrastromal pre-Descemet tunnel.Methods  This monocentric, retrospective study evaluated all patients treated with Femto-DALK between January 2020 and December 2023 at the Department of Ophthalmology at the University of Düsseldorf (Germany). The iOCT-guided tunnel was generated 30 microns anterior of Descemet's membrane. BB generation, surgery time and conversion to penetrating keratoplasty (PK) were analyzed.Results  A total of 42 eyes of 41 patients were identified. BB creation was successful in 78.6% of cases. Intraoperative conversion to PK was necessary in 28.6% of the eyes and microperforation of Descemet's membrane (DM) occurred in 16.7% of completed DALKs. Mean operation time was 118.6 ± 40.68 min. Among successful Femto-DALKs (n = 30), double anterior chamber was observed in 26.7%, and re-bubbling was needed in 23.3%. Re-keratoplasty was performed in one eye (3.3%).Conclusion  Femto-DALK with an iOCT-guided pre-Descemet tunnel generation is a feasible technique that achieves BB success rates comparable to the upper range reported for manual dissection, without a clear demonstrated improvement over manual technique.
SN  - 1471-2415
ER  -