In Vitro Evaluation of the Feasibility of Slit-Lamp Nd: YAG Laser Descemetorhexis.

Purpose: To evaluate in vitro the feasibility and tissue effects of using a slit-lamp neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to create a central descemetorhexis in human donor corneas.

Methods: Twelve human donor corneas ineligible for transplantation were divided into 2 groups, A and B. Group A: 2 "healthy" corneas, which were used to validate the laser parameters; group B: 10 corneas with endothelial guttae, which were used to perform a 4-mm descemetorhexis. Slit-lamp photography, light microscopy, corneal endothelial microscopy, Scheimpflug imaging, optical coherence tomography (OCT) imaging, and histological staining were performed to visualize the efficacy of slit-lamp Nd:YAG laser removal of Descemet membrane and to assess potential tissue damage to the overlying stroma and peripheral endothelium.

Results: In all corneas, an Nd:YAG laser 4-mm central descemetorhexis could be consistently performed. The total energy required ranged from 1143 to 2784 mJ. Side effects such as stromal pitting and corneal swelling were observed.

Conclusions: Creating a central descemetorhexis with a slit-lamp Nd:YAG laser proved feasible in vitro. This new technical approach might open the door to a customized in vivo "descemetorhexis-only" treatment for Fuchs endothelial corneal dystrophy eyes, while avoiding the risks associated with intraocular surgery.