We hypothesize that femtosecond laser technology previously developed for refractive surgical applications can be optimized to perform therapeutic anterior lamellar corneal transplant procedures that are clinically superior to full-thickness and traditional lamellar techniques. Currently, full thickness transplants account for the vast majority of the 45,000 annual corneal transplants performed in the U.S. Most of these procedures could theoretically be replaced with lamellar procedures that include transplantation of either anterior or posterior corneal structures. Replacement of full-thickness corneal transplants with laser lamellar procedures could dramatically reduce complications, lower surgical skill requirements, and speed visual recovery (often delayed with current techniques due to induced astigmatism). In addition, use of a single donor cornea for two patients would significantly improve the shortage that currently exists for donated tissue. To test this hypothesis, we will: Develop hardware and software modifications to the existing femtosecond laser corneal surgery platform : Compare laser-tissue interactions in transparent and translucent tissue to simulate lamellar dissection in normal versus diseased corneas: Model and test self sealing wound architectures for anterior lamellar transplants Model and test self sealing wound architectures for endostromal transplantation through a hinged anterior flap. The goal of the Phase I project will be introduction of software/hardware modifications, as well as the development of surgical techniques for the above procedures that can then undergo clinical testing in a Phase II proposal.
