Corneal lathing using the excimer laser and a computer-controlled positioning system: Part I--Lathing of...

Precise lathing of epikeratoplasty lenticules is difficult to achieve with the cryolathe due to unpredictable expansion of the lathing tools and the corneal tissue during the freezing process. In addition, the procedure destroys all viable cells in the transplant thereby possibly contributing to the prolonged period of visual rehabilitation. Non-freezing techniques using the microkeratome or the rotor-trephine, on the other hand, are technically demanding, can cause mechanical damage during cutting or fixation, and, have not given consistently reproducible refractive results. A new system is presented that allows a variable laser ablation of donor corneas into lenticules for aphakic and myopic epikeratoplasty, as well as for lamellar keratoplasty. With the help of a computer-controlled positioning system that uses high-precision micropositioning elements (both translation and rotational stages) the donor cornea is moved, epithelial side down, in a holding device in front of a focused excimer laser beam (ArF, lambda = 193 nm). This photoablation lathing process assures the viability of the stromal cells in the lenticule in close approximation to the treated surface. The user friendly computer software allows the fast and convenient selection of a variety of parameters, such as the diameter of the optical zone, the shape of the wing zone, the refractive power, the central thickness of the lenticule and the overall contour of the transplant. The first laboratory data of lenticules prepared from human corneas with this "Excimer Laser Corneal Shaping System" are presented.