Based on our previous clinical experiences in minimally invasive diode laser-induced welding of corneal tissue in
penetrating keratoplasty (PK), i.e. full-thickness transplant of the cornea, we combined this technique with the use of a
femtosecond laser for applications in lamellar (LK) and endothelial (EK) keratoplasty. In LK, the femtosecond laser was
used to prepare donor button and recipient corneal bed; the wound edges were stained with a water solution of
Indocyanine Green (ICG) and then irradiated with a diode laser emitting in CW mode to induce stromal welding.
Intraoperatory observations and follow-up results up to 6 months indicated the formation of a smooth stromal interface,
total absence of edema as well as inflammation, and reduction of post-operative astigmatism, as compared with
conventional suturing procedures. In EK the femtosecond laser was used for the preparation of a 100 &mgr;m thick, 8.5mm
diameter donor corneal endothelium flap. The flap stromal side was stained with ICG. After stripping the recipient
Descemet's membrane and endothelium, the donor flap was positioned in the anterior chamber on the inner face of the
cornea by an air bubble and secured to the recipient cornea by diode laser pulses delivered by means of a fiberoptic
contact probe introduced in the anterior chamber, which produced welding spots of 200 &mgr;m diameter. Femtosecond laser
sculpturing of the donor cornea provided lamellar and endothelial flaps of preset and constant thickness. Diode laserinduced
welding showed a unique potential to permanently secure the donor flap in place, avoiding postoperative
displacement and inflammation reaction.