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Purpose Deep anterior lamellar keratoplasty (DALK) has become a safe and standardized technique for the treatment of corneal diseases. The use of femtosecond lasers for corneal trephination in DALK allows for a precise and controlled corneal trephination very close to Descemet’s membrane (DM) which is important for a successful pneumatic dissection and results in separation of Pre-Descemet’s layer (Dua’s layer, PDL) and/or DM from the stroma. However, even with newer curved contact interfaces the cornea becomes massively warped during trephination causing irregular trephination patterns which results in high postoperative astigmatism. Here we present a novel technique of Femto-DALK using a non-contact liquid interface where the cornea keeps its natural curvature during the complete laser process. Methods Case series of two patients, which underwent femtosecondlaser-assistant deep anterior lamellar keratoplasty by using a non-contact liquid interface. The laser device (Ziemer LDV Z8, Ziemer Ophthalmic Systems AG, Port, Switzerland) was used for trephination of the donor and recipient cornea. In one patient Femto-DALK was combined with femtolaser-assisted cataract surgery (Femto-Phaco). Read-out parameters were the feasibility of the technique and postoperative outcome. Results Trephination was successful in both cases leading to a circular trephination very close to the recipients’ Descemet’s membrane. In both patients a big bubble type 1 was induced successfully. Conclusions Femtosecondlaser-assisted DALK using a liquid interface is a novel procedure representing an alternative to manual DALK or Femto-DALK with a contact interface. Future studies need to evaluate outcomes and complication rates in comparison to manual DALK and microscope-integrated Optical Coherence Tomography-aided DALK.

Purpose To assess the evolution of clinical outcomes of more than 1300 Descemet membrane endothelial keratoplasties (DMEKs) alone or in combination with cataract surgery (triple DMEK) throughout a 5-year period at a single center, performed by 2 already experienced DMEK surgeons. Design Retrospective trend study. Methods Review of charts between July 2011 and July 2016 at the Department of Ophthalmology, University of Cologne, Germany. Results A total of 1340 out of 1340 eyes with sufficient information were included. Six-month and 12-month best spectacle-corrected visual acuity (logMAR) had already reached high levels for the surgeries performed in 2011 (0.10 ± 0.06 and 0.09 ± 0.07, respectively) and did not further improve in later years ( P = .272). Likewise, endothelial cell loss (ECL) and central corneal thickness (CCT) reached comparable levels independently of the year of surgery (average 12-month ECL was 38% ± 15% and average 6-month CCT decrease was 19% ± 11%). However, there was a decrease in the rebubbling rate, from 68% in 2011, 67% in 2012, and 70% in 2013 to 53% in 2014, 29% in 2015, and 16% in 2016, which was associated with the introduction of 20% sulfur hexafluoride (SF 6 ) instead of room air for anterior chamber tamponade in 2015 (n = 986; P P Conclusions After an initial learning curve in DMEK surgery, results of visual acuity and ECL do not seem to further improve. However, the complication rate continuously declines, at least over the subsequent 5-year period analyzed herein.

Purpose To analyze the effect of intensified topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK) on the incidence of postoperative cystoid macular edema (CME). Design Single-center comparative clinical study with historical controls. Methods Setting: Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year. Patients: Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. Inclusion Criterion: Triple-DMEK surgery. Exclusion Criteria: Prior retinal surgery, history of prior CME. Interventions: Prednisolone acetate eye drops 1% 5 times daily for the first week after surgery. After an internal change of therapy regimen: Prednisolone acetate eye drops 1% hourly for the first postoperative week. We compared 75 consecutive eyes before with 75 consecutive eyes after the change of therapy regimen. Patients received macular spectral-domain optical coherence tomography (SD OCT) preoperatively, as well as 6 weeks and 3 and 6 months post surgery. Main Outcome Measure: Development of CME detected by macular SD OCT during 6 months postoperatively. Results Both groups were comparable regarding baseline age, sex, central corneal thickness, rebubbling rate, and visual acuity. With topical steroid therapy 5 times per day during the first postoperative week, we observed 9 cases of subsequent CME (12%). With hourly topical steroid therapy none of the patients developed CME subsequently ( P = .003). Apart from the topical steroids during the first week, medical treatment was identical in both groups. Conclusions Early intensified postoperative topical steroid therapy constitutes an effective prophylactic treatment to reduce incidence of CME after triple-DMEK surgery.