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Nishant P, Gurnani B, Singh P, Sinha S, Kaur K, Kumar A, Sinha RK. Current concepts and recent trends in endothelial keratoplasty. World J Transplant 2025; 15. [DOI: 10.5500/wjt.v15.i2.102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 01/15/2025] [Accepted: 01/21/2025] [Indexed: 02/21/2025] Open
Abstract
Endothelial keratoplasty (EK) is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue, which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s) with healthy donor tissue, to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity. Recently, the pathophysiology of corneal decompensation is increasingly being researched upon. Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK. In addition, EK techniques have progressed towards using thinner tissue, optimizing visual outcomes. Improvements have enabled better donor tissue formulation, usage, and attachment, and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection. However, challenges are encountered in various complex clinical scenarios including eyes with prior intraocular surgery, complex anterior chamber anatomy, glaucoma, ocular surface disease etc. These complexities demand tailored surgical strategies, including modifications in graft handling, instrumentation, and postoperative management to ensure success. Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases. The choice of procedure depends on multiple factors, including the surgeon's experience, patient's ocular anatomy, and the specific clinical scenario. This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications, contraindications, surgical techniques, clinical situations, community aspects and future directions pertaining to EK.
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Affiliation(s)
- Prateek Nishant
- Department of Ophthalmology-Refractive Surgery, Uvea and Neuro-Ophthalmology, Akhand Jyoti Eye Hospital, Mastichak, Saran 841219, Bihar, India
| | - Bharat Gurnani
- Department of Cataract, Cornea, External Diseases, Trauma, Ocular Surface, Refractive Surgery and Contact Lens, Gomabai Netralaya and Research Center, Neemuch 458441, Madhya Pradesh, India
| | - Prabhakar Singh
- Department of Ophthalmology-Cornea and Ocular Surface, All India Institute of Medical Sciences, Kalyani 741245, West Bengal, India
| | - Sony Sinha
- Department of Ophthalmology-Vitreo-Retina, Neuro-Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Kirandeep Kaur
- Department of Cataracts, Pediatric Ophthalmology and Strabismus, Gomabai Netralaya and Research Center, Neemuch 458441, Madhya Pradesh, India
| | - Ashish Kumar
- Department of Cornea and Refractive Surgery, Laxmi Netralaya, Jamal Road, Patna 800001, Bihar, India
| | - Ranjeet Kumar Sinha
- Department of Community Medicine, Patna Medical College, Patna 800004, Bihar, India
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Jafari K, Ashena Z, Niestrata M. A Review of Outcomes of Descemet Membrane Endothelial Keratoplasty and Descemet Stripping Automated Endothelial Keratoplasty Interventions in Patients with Pre-Existing Glaucoma. J Clin Med 2025; 14:3534. [PMID: 40429529 PMCID: PMC12111952 DOI: 10.3390/jcm14103534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 05/13/2025] [Accepted: 05/15/2025] [Indexed: 05/29/2025] Open
Abstract
Glaucoma is known to impair the function of corneal endothelial cells for various reasons, which increases the likelihood of patients with glaucoma requiring endothelial keratoplasty. Among the techniques available, Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) each present unique challenges, particularly for those with a history of glaucoma surgery. We conducted a literature review to evaluate the outcomes of DMEK and DSAEK in glaucoma patients, focusing on factors such as visual prognosis, graft survival, glaucoma exacerbations, and any necessary surgical modifications. The findings indicate that DMEK tends to provide better visual outcomes compared to DSAEK, with a lower rate of steroid responders due to a shorter postoperative steroid regimen. While DMEK has shown a higher incidence of graft detachment and a lower rate of graft rejection, compared to DSAEK, in the general population, the specific data regarding these outcomes in glaucoma patients remain scarce in the existing literature. Overall, the survival rates of both grafting techniques do not show significant differences within the glaucoma patient population. To draw more definitive conclusions about graft survival between the two methods, a greater number of comparative studies with longer follow-up periods is needed.
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Affiliation(s)
- Keya Jafari
- Moorfields Eye Hospital, London EC1V 2PD, UK;
| | - Zahra Ashena
- Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, UK
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Olafsdottir T, Hootak F, Forslund C, Olafsdottir E, Gustafsson I. Graft detachment rates in surgeon-cut and pre-cut tissue for DSAEK transported in different mediums. Acta Ophthalmol 2025; 103:281-288. [PMID: 39508714 PMCID: PMC11986399 DOI: 10.1111/aos.16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 10/23/2024] [Indexed: 11/15/2024]
Abstract
PURPOSE To analyse graft detachment rates after Descemet stripping automated endothelial keratoplasty (DSAEK) using surgeon-cut grafts and pre-cut grafts transported in different mediums. METHODS A retrospective study of graft detachment rates including 265 surgeries (240 patients) performed between 2019 and 2023. The DSAEK grafts were either surgeon-cut (n = 135) or pre-cut and transported in a dextran-containing medium (n = 82) or in a dextran-free medium (n = 48). All surgeries were performed by a single surgeon (I.G.). The surgeries were categorised according to whether the recipients' eyes had, or did not have, factors associated with an increased risk of graft detachment. Detachment rates were compared for all patients receiving the different kinds of graft, and only for those without risk factors. RESULTS A significantly higher detachment rate was found among patients receiving pre-cut grafts transported in a dextran-containing medium (32.9%), compared to surgeon-cut grafts (14.1%, p = 0.002), and pre-cut grafts transported in a dextran-free medium (6.3%, p = 0.002) for all recipients (those with and without risk factors for graft detachment). When analysing recipients without risk factors for graft detachment, the detachment rate was still significantly higher with pre-cut tissue transported in a dextran-containing medium (26.9%), compared to surgeon-cut tissue (8.3%, p = 0.002) and pre-cut tissue transported in a dextran-free medium (3.6%, p = 0.01). CONCLUSIONS The use of pre-cut DSAEK tissue transported in a dextran-containing medium significantly increases the risk of graft detachment requiring re-bubbling.
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Affiliation(s)
- Thorbjörg Olafsdottir
- Department of Ophthalmology, Department of Clinical Sciences, Skåne University HospitalLund UniversityLundSweden
| | - Faisal Hootak
- Department of OphthalmologyCentralsjukhuset KristianstadKristianstadSweden
| | | | - Eydis Olafsdottir
- Department of Ophthalmology, Department of Clinical Sciences, Skåne University HospitalLund UniversityLundSweden
| | - Ingemar Gustafsson
- Department of Ophthalmology, Department of Clinical Sciences, Skåne University HospitalLund UniversityLundSweden
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Berger T, Seitz B, Suffo S, Gvozdenovic R, Abu Dail Y, Daas L. Fellow Eye Comparison of Tomographic Parameters and Higher-Order Aberrations in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty. Klin Monbl Augenheilkd 2025. [PMID: 40267949 DOI: 10.1055/a-2558-2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
PURPOSE To assess the functional outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial corneal dystrophy in fellow eyes. METHODS Retrospective study of 28 eyes (14 patients) undergoing UT-DSAEK in one eye and DMEK in the fellow eye with a follow-up of at least one year. Main outcomes were best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), and anterior and posterior tomographic parameters, including corneal higher-order aberrations (HOAs). RESULTS The UT-DSAEK and DMEK groups showed no differences in donor characteristics or preoperative corneal tomographic parameters. BCVA improved in both groups, but visual recovery was faster in the DMEK group. CCT and ECD decreased in the UT-DSAEK and DMEK groups, but without differences between the groups. Posterior mean keratometry and posterior Q-value increased in the UT-DSAEK and DMEK groups with higher values of both parameters in the UT-DSAEK group. As regards corneal aberrations, higher root mean-square values for HOAs of the posterior cornea and higher values of posterior Trefoil were evident in the UT-DSAEK group than in the DMEK group. CONCLUSION Visual quality after endothelial keratoplasty might depend not on visual acuity alone, but also on corneal aberrations and asphericity of the anterior and posterior corneal surface. The results support the benefits of DMEK over UT-DSAEK, suggesting the need for long-term studies with a larger number of patients.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Ranko Gvozdenovic
- Department of Ophthalmology, Clinic for Eye Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Yaser Abu Dail
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
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Snyder AJ, Bauer AJ, Straiko MD, Terry MA, Chen J. Long-term Outcomes of Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty Under a Failed Penetrating Keratoplasty Graft. Cornea 2025:00003226-990000000-00817. [PMID: 39938092 DOI: 10.1097/ico.0000000000003828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 01/03/2025] [Indexed: 02/14/2025]
Abstract
PURPOSE To compare long-term outcomes of Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK) under a failed penetrating keratoplasty (PKP) graft. METHODS We retrospectively reviewed consecutive surgeries (Febuary 2007-September 2023) that received a DSAEK graft (n = 52) or DMEK graft (n = 51) under a failed PKP. Postoperative complication rates of primary graft failure (PGF), late endothelial graft failure, graft rejection, rebubble, and steroid response were recorded. Endothelial cell loss (ECL) at 6-month, 2-year, and 5-year postoperative visits were calculated. Graft survival time and survival probability at 5 years was determined using a Kaplan-Meier analysis. Twelve DMEK and 17 DSAEK eyes had 5-year follow-up. Eyes with a glaucoma filtration tube, trabeculectomy, or anterior chamber intraocular lens were excluded. RESULTS Rebubble rate was significant between DSAEK and DMEK cohorts (5.8%, 29.4%, P = 0.0017*). Rate of rejection, late endothelial graft failure, steroid response, 6-month ECL, 2-year ECL, 5-year ECL, survival probability, and 5-year mean survival time were not significant between DSAEK and DMEK cohorts [(9.6%, 5.9%, P = 0.7155), (13.5%, 9.8%, P = 0.7602), (9.6%, 11.8%, P = 0.7602), (32.0% ± 21.0%, 41.65% ± 25.6%, P = 0.1949), (55.8% ± 21.6%, 62.5% ± 19.8%, P = 0.4463), (59.5% ± 35.0%, 72.5% ± 5.7%, P = 0.3468), (88.5%, 84.3%, P = 0.483), (53.9 ± 2.4 confidence interval, 49.1-58.6 months, 52.7 ± 2.9 confidence interval, 47.0-58.5 months)]. PGF occurred in 0/52 (0%) and 3/51 (5.9%) eyes in the DSAEK and DMEK cohorts with nonsignificant trends favoring DSAEK ( P = 0.1178). CONCLUSIONS The only significant difference between DSAEK and DMEK cohorts was rebubble rate. However, nonsignificant trends favored PGF and ECL in the DSAEK cohort. Further investigation is warranted to determine if DSAEK provides better short-term and similar long-term outcomes compared with DMEK under a failed PKP.
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Affiliation(s)
- Alyssa J Snyder
- Cornea Service, Devers Eye Institute, Portland, OR
- Albany Medical College, Albany, NY; and
| | | | | | - Mark A Terry
- Cornea Service, Devers Eye Institute, Portland, OR
| | - Jessica Chen
- Cornea Service, Devers Eye Institute, Portland, OR
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Zwingelberg SB, Karabiyik G, Gehle P, von Brandenstein M, Eibichova S, Lotz C, Groeber-Becker F, Kampik D, Jurkunas U, Geerling G, Lang G. Advancements in bioengineering for descemet membrane endothelial keratoplasty (DMEK). NPJ Regen Med 2025; 10:10. [PMID: 39952985 PMCID: PMC11828897 DOI: 10.1038/s41536-025-00396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 01/27/2025] [Indexed: 02/17/2025] Open
Abstract
Corneal diseases are the third leading cause of blindness worldwide. Descemet's Membrane Endothelial Keratoplasty (DMEK) is the preferred surgical technique for treating corneal endothelial disorders, relying heavily on high-quality donor tissue. However, the scarcity of suitable donor tissue and the sensitivity of endothelial cells remain significant challenges. This review explores the current state of DMEK, focusing on advancements in tissue engineering as a promising solution to improve outcomes and address donor limitations.
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Affiliation(s)
| | - Gizem Karabiyik
- Department of Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Paul Gehle
- Department of Urology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Melanie von Brandenstein
- Department of Urology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sabina Eibichova
- University Hospital Würzburg, Department of Tissue Engineering and Regenerative Medicine, Würzburg, Germany
| | - Christian Lotz
- University Hospital Würzburg, Department of Tissue Engineering and Regenerative Medicine, Würzburg, Germany
- Fraunhofer Institute for Silicate Research ISC Translational Center Regenerative Therapies, Würzburg, Germany
| | - Florian Groeber-Becker
- Department of Ophthalmology, University Hospital of Duesseldorf, Duesseldorf, Germany
- Fraunhofer Institute for Silicate Research ISC Translational Center Regenerative Therapies, Würzburg, Germany
| | - Daniel Kampik
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Ula Jurkunas
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Institute, Boston, MA, USA
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Gregor Lang
- Department of Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany.
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Straiko MMW, Letchworth EV, Dye PK, Galloway JD, Tran KD. Simple Modification of a DSAEK Carrier Enables Graft Insertion by Injection Without Compromising Endothelial Cell Viability. Cornea 2025; 44:98-103. [PMID: 39058227 DOI: 10.1097/ico.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE We evaluate the quality and feasibility of preloading Descemet stripping automated endothelial keratoplasty (DSAEK) grafts into a modified EndoGlide Ultrathin system for graft injection. METHODS DSAEK grafts were prepared by experienced processing technicians at 2 separate locations, loaded into a modified EndoGlide Ultrathin, and placed in storage media. Grafts processed at one location were shipped cross-country overnight to the other location and were examined on arrival for positioning within the modified EndoGlide Ultrathin. All grafts were ejected and analyzed for endothelial cell loss (ECL) with calcein acetoxymethyl staining and FIJI segmentation. A subset of grafts was measured by optical coherence tomography for graft thickness 1 hour after cut, 1 hour after loading, and 1 day after loading. RESULTS No grafts were displaced from the modified carrier over 3 shipping events (n = 9), and all grafts (n = 18) were successfully ejected. Grafts loaded into the modified carrier and ejected exhibited no more cell loss than grafts loaded into the standard carrier and removed by pull-through (14.0% ± 2.8% vs. 12.2% ± 3.4%, respectively, P = 0.24). Carrier modification skills can be successfully transferred as grafts loaded by a processing technician new to carrier modification were within the acceptable limit of 25% ECL for transplant DSAEK grafts. Graft thickness increased significantly ( P < 0.05) between the postcut and 1-hour postload measurement and the postcut and 24-hour postload measurement. CONCLUSIONS The EndoGlide Ultrathin can be modified to enable its use for graft injection while not compromising the ability to use the pull-through method for graft delivery. Preloaded DSAEK grafts swell significantly during the 24-hour storage period, and patterns of ECL may be linked to swelling.
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Affiliation(s)
| | - Emma V Letchworth
- Transplant Services Center, University of Texas Southwestern Medical Center, Dallas, TX
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Dhupar N, AlShaker S, Chai J, Yan J, Little N, Humphreys C, Chan CC, Ong Tone S. Validation of preloaded DMEK donor tissues: a laboratory-based study on endothelial cell viability and comparison of two F-mark inks. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e673-e681. [PMID: 38513716 DOI: 10.1016/j.jcjo.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/24/2023] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To investigate endothelial cell loss (ECL) associated with Descemet membrane endothelial keratoplasty (DMEK) donor tissues preloaded in the DMEK RAPID transport system after 1 and 5 days and to compare prestamping with 2 different F-mark inks. METHODS DMEK donor tissues were stripped, marked with gentian violet dye applied as an F-mark, trephined, stained with trypan blue, and then preloaded into the DMEK RAPID transport system by an eye bank technician. Preloaded DMEK tissues were then unfolded and stained with calcein AM after 1 or 5 days of storage. Tissues were imaged, analyzed for total tissue ECL, and immunostained for corneal endothelium markers zonular occludens-1 and xCD166. Additionally, ECL and the intensity of an F-mark caused by 2 different inks were quantified. RESULTS Preloaded DMEK tissues displayed an average ECL of 11.9% ± 4.5% (n = 8) at 1 day and 9.9% ± 4.2% (n = 9) at 5 days. No difference was found between the 2 groups. Zonular occludens-1 and activated leukocyte cell adhesion molecule (ALCAM; also know as CD166) staining showed that the corneal endothelial monolayer remained intact on preloaded tissues. On 5-day preloaded DMEK tissues, the average ECL and mean grayscale caused by the Keir Surgical ink F-mark and the Cardinal Health ink F-mark were 4.3% ± 0.8% and 158.5 ± 13.9% and 5.0% ± 1.1% and 142.9% ± 20.0%, respectively. No difference was found between the F-mark inks. CONCLUSION Preloaded DMEK donor tissues resulted in an acceptable ECL range after 1 and 5 days of storage and were deemed suitable for transplantation. Both F-mark inks are acceptable for prestamping preloaded DMEK tissues prior to surgical transplantation with comparable ECL and intensities.
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Affiliation(s)
- Narisa Dhupar
- Sunnybrook Research Institute, Toronto, ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - Sara AlShaker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jenny Chai
- Eye Bank of Canada Ontario Division, Toronto, ON
| | - Judy Yan
- Sunnybrook Research Institute, Toronto, ON
| | - Ness Little
- Sunnybrook Research Institute, Toronto, ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | | | - Clara C Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON; Eye Bank of Canada Ontario Division, Toronto, ON
| | - Stephan Ong Tone
- Sunnybrook Research Institute, Toronto, ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.
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Kim EC, Ha M, Kim DR, Yoon YC, Whang WJ, Na KS, Kim HS, Kim MS, Hwang HS. Double-Cannula Maneuver for the Double-Roll Configuration of Donor Descemet Membrane Outside Recipient Anterior Chamber During Descemet Membrane Endothelial Keratoplasty. Cornea 2024; 43:1436-1440. [PMID: 39137436 DOI: 10.1097/ico.0000000000003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/03/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE The purpose of this study was to present a new surgical technique to convert a single roll of Descemet membrane (DM) into a double roll using 2 cannulas in a balanced salt solution-filled Petri dish during DM endothelial keratoplasty. METHODS A single DM roll stained with trypan blue was placed in a balanced salt solution-filled Petri dish. Two cannulas (28G) were introduced from opposite ends of the single roll, inserted into the roll, and slowly spread apart to change the single roll into a double roll. The DM was aspirated into the modified Jones tube and loaded, maintaining a double-roll configuration with endothelium-down orientation in a bevel-up position. The modified Jones tube with the bevel down was inserted into the recipient anterior chamber through the main wound. The modified Jones tube was rotated to the bevel-up orientation. After checking the graft orientation, the DM was inserted into the recipient anterior chamber. The double-roll DM was easily unfolded by tapping the center of the cornea using a cannula. A 28G cannula was inserted under the DM, and the anterior chamber was filled with air. RESULTS Three months after surgery, the patient's corrected visual acuity in the right eye was 6/7.5 and the endothelial cell count was 1095/mm 2 . The corneal thickness was 533 μm, and the cornea was clear. CONCLUSIONS The double-cannula maneuver mechanically changes the single roll of the donor DM to a double roll outside the recipient anterior chamber, making DM unfolding easier and minimizing the risk of upside-down apposition of the donor DM.
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Affiliation(s)
- Eun Chul Kim
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Minji Ha
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Da Ran Kim
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Young Chae Yoon
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Woong-Joo Whang
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Hyun-Seung Kim
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
| | - Man Soo Kim
- Gangnam St. Mary's One Eye Clinic, Seoul, Republic of Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea ; and
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Wiley ZC, Huang X, Staggers KA, Hamill MB. Comparison of 20% SF6 and 6% C3F8 Gas for Anterior Chamber Tamponade in Endothelial Keratoplasty. Cornea 2024; 43:1238-1244. [PMID: 38251881 PMCID: PMC11365599 DOI: 10.1097/ico.0000000000003469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The aim of this study was to compare the rates of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) between patients who had anterior chamber (AC) graft tamponade with 20% sulfur hexafluoride gas (SF6) and 6% perfluoropropane gas (C3F8). METHODS The charts of 431 patients undergoing EK from June 8, 2010, to April 16, 2023, were reviewed. Patients undergoing EK alone as well as combined procedures with cataract extraction and intraocular lens implantation were included. Eyes with tube shunts, anterior chamber intraocular lenses, and large peripheral iridotomy with posterior loss of bubble, and patients undergoing cyclophotocoagulation or synechialysis were excluded. All rebubble procedures were performed within 1 month after initial surgery. RESULTS A total of 346 eyes using SF6 and 167 eyes using C3F8 were analyzed. Overall, 46 eyes (9%) required rebubbling; 33 eyes (10%) in the SF6 group and 13 eyes (8%) in the C3F8 group. For those patients undergoing DMEK, the odds of requiring rebubbling in the C3F8 group were about 22% lower than that of patients in the SF6 group (operating room [OR]: 0.782; P < 0.001). For patients undergoing DSEK, however, the gas type did not significantly affect rebubbling rates ( P = 0.99). CONCLUSIONS For DMEK, utilization of 6% C3F8 as an AC tamponade was associated with a significantly lower odds of graft rebubbling compared with 20% SF6. Gas type did not result in a significant difference for DSEK. Utilization of 6% C3F8 for graft tamponade could be considered to reduce graft detachment rates in DMEK.
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Affiliation(s)
- Zachary C. Wiley
- Baylor College of Medicine, Cullen Eye Institute, Houston, TX; and
| | - Xiaofan Huang
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX
| | - Kristen A. Staggers
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX
| | - M. Bowes Hamill
- Baylor College of Medicine, Cullen Eye Institute, Houston, TX; and
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Samarawickrama C. Novel Trephine for Descemet Membrane Endothelial Keratoplasty Surgery Improves Surgical Preparation Time and Graft Quality: Pilot Data From the "Number 7" Endothelial Keratoplasty Trephine. Cornea 2024:00003226-990000000-00682. [PMID: 39264752 DOI: 10.1097/ico.0000000000003700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE To report the safety and efficacy of a novel asymmetric marking trephine for Descemet membrane endothelial keratoplasty (DMEK) tissue preparation. The trephine design incorporates optimized curves to distribute mechanical forces and minimize the risk of tears without loss of total endothelial cell volume transplanted compared with a standard 8.00 mm circular transplant. METHODS A retrospective case series of 40 consecutive DMEK operations comparing 20 cases using the "Number 7" trephine against 20 using a modified shark fin technique as standard. Patient and donor characteristics, tissue preparation time and complications, total surgical time, intraoperative and postoperative complications, and endothelial cell counts at 3 months postsurgery are reported. RESULTS DMEK tissue preparation was significantly faster using the "Number 7" trephine (5.4 vs. 7.6 minutes, P = 0.008). Further, fewer complications arose during tissue preparation (0 vs. 2 complications) despite the faster preparation time. Total surgical time was similar between techniques; however, time spent manipulating the graft was reduced (5.1 vs. 6.8 minutes, P = 0.007) primarily because of the lower tissue preparation complications. Fewer postoperative complications were observed (1 vs. 3, of which 1 in the standard technique group requiring a redo-DMEK), again due to the reduced tissue preparation complications. The 3-month endothelial cell count was comparable between techniques (P > 0.05). CONCLUSIONS Use of the "Number 7" trephine led to faster and safer DMEK tissue preparation, which in turn reduced graft manipulation times and postoperative complications without compromising total endothelial cell volume transplanted. This novel device is ideal for use by surgeons who prepare their own DMEK tissue and within tissue banks who provide prestripped and preloaded DMEK tissue.
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Affiliation(s)
- Chameen Samarawickrama
- Faculty of Medicine and Health, Clinical Ophthalmology and Eye Health, Westmead Institute for Medical Research (WIMR), Save Sight Institute, Westmead and Central Clinical Schools, The University of Sydney, Sydney, Australia
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12
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Rodríguez-Calvo-de-Mora M, Giménez-Almenara-Amo J, Mataix-Albert B, Arias-Alcalá M, García-Montesinos-Gutiérrez J, Rocha-de-Lossada C, Villalba-Montoro R, Díaz-Gallardo MS, Cuende N, Álvarez-Márquez A. Andalusian Public Eye-Banks: a decade of continuous improvement. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:383-391. [PMID: 38909891 DOI: 10.1016/j.oftale.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/05/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES To show donation data, number of keratoplasties and the changes in transplant indications and techniques that occurred in Andalusia in the period from 2013 to 2022. MATERIALS AND METHODS The present work is a retrospective and descriptive study that included all keratoplasties performed between January 2013 and December 2022 in Andalusia, as well as the evolution of the cornea donation and transplant activity of the public and private hospitals pertaining to the waiting list management system of the Public Health System of Andalusia. Transplants performed in private centers with corneas from outside Andalusia were excluded. RESULTS Cornea donation activity in Andalusia in the decade 2013-2022 has experienced a growth of more than 126%, while overall transplant activity has increased by 157% in public hospitals. Penetrating keratoplasty has decreased from 83% in 2013 to 43% in 2022, while lamellar techniques have increased from 17% to 57% in this same period. Since 2018, more lamellar transplants are performed than penetrating transplants. Regarding indications, endothelial conditions already represent the first cause of transplantation. In 2022 alone, the public Andalusian Eye Banks evaluated 1,054 corneas and prepared 281 endothelial grafts. CONCLUSION In the decade from 2013 to 2022 in Andalusia there has been an increase in donation activity and the number of keratoplasties. The public Eye Banks implementation in this period has played a key role in the widespread adoption of lamellar keratoplasty techniques and has enabled the transition to perform a greater number of lamellar keratoplasties compared to penetrating keratoplasty.
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Affiliation(s)
- M Rodríguez-Calvo-de-Mora
- Qvision, Departmento Oftalmología, VITHAS Almería Hospital, Almería, Spain; Unidad de Córnea y Superficie Ocular, Departamento Oftalmología, VITHAS Málaga. Málaga, Spain; Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain.
| | - J Giménez-Almenara-Amo
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain; Unidad de Córnea y Cirugía Refractiva, Clínica Baviera Córdoba, Córdoba, Spain
| | - B Mataix-Albert
- Unidad de Córnea y Superficie Ocular, Hospital Universitario Virgen Macarena, Sevilla, Spain; Unidad de Córnea y Superficie Ocular, Hospital Quirón Ave María, Sevilla, Spain
| | - M Arias-Alcalá
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - J García-Montesinos-Gutiérrez
- Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Unidad de Córnea y Superficie Ocular, Miranza Málaga, Málaga, Spain; HM Hospitales Málaga, Málaga, Spain
| | - C Rocha-de-Lossada
- Qvision, Departmento Oftalmología, VITHAS Almería Hospital, Almería, Spain; Unidad de Córnea y Superficie Ocular, Departamento Oftalmología, VITHAS Málaga. Málaga, Spain; Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Universidad de Sevilla, Departamento de Cirugía, Área de Oftalmología, Sevilla, Spain
| | | | | | - N Cuende
- Coordinación Autonómica de Trasplantes de Andalucía, Spain
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13
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Rodríguez-Calvo-de-Mora M, Giménez-Almenara-Amo J, Mataix-Albert B, Arias-Alcalá M, García-Montesinos-Gutiérrez J, Rocha-de-Lossada C, Villalba-Montoro R, Díaz-Gallardo M, Cuende N, Álvarez-Márquez A. Bancos de ojos públicos de Andalucía: una década de mejora continua. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2024; 99:383-391. [DOI: 10.1016/j.oftal.2024.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
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14
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Lin CC, Chamberlain WD, Kakigi C, Arnold BF, Rose-Nussbaumer J. Mediators of Visual Acuity in Descemet Membrane Endothelial Keratoplasty and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2024; 43:853-859. [PMID: 37986182 DOI: 10.1097/ico.0000000000003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this study was to investigate mediators of visual acuity in ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) compared with Descemet membrane endothelial keratoplasty (DMEK). METHODS This was a prespecified secondary analysis of the Descemet Endothelial Thickness Comparison Trial, a prospective, randomized controlled trial comparing UT-DSAEK with DMEK. Subjects with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy presenting to 2 academic centers were enrolled and randomized to either UT-DSAEK (n = 25 eyes) or DMEK (n = 25 eyes). Higher order aberrations (HOAs) and corneal densitometry were measured with Pentacam Scheimpflug imaging at 3, 6, 12, and 24 months. RESULTS The posterior corneal surface at the 6.0-mm optical zone had significantly less total HOAs ( P <0.001) in the DMEK group compared with UT-DSAEK at 24 months. Anterior and posterior corneal densitometry improved from baseline to 24 months for both UT-DSAEK and DMEK, but there was no significant difference between the 2 groups. Corneal densitometry and posterior HOAs were both associated with best-corrected visual acuity ( P <0.05). DMEK had 1.3 logarithm of the minimum angle of resolution better visual acuity compared with UT-DSAEK at 24 months. Approximately 64% of this effect was mediated through posterior HOAs, whereas none was mediated through anterior HOAs or densitometry. CONCLUSIONS Decreased posterior HOAs mediate better visual acuity and account for improved vision after DMEK compared with UT-DSAEK. Corneal light scatter as measured by densitometry is similar between UT-DSAEK and DMEK, indicating that the increased thickness and stromal-stromal interface in UT-DSAEK do not significantly affect visual acuity.
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Affiliation(s)
- Charles C Lin
- Byers Eye Institute, Stanford University, Palo Alto, CA
| | - Winston D Chamberlain
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR; and
| | - Caitlin Kakigi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR; and
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA
| | - Jennifer Rose-Nussbaumer
- Byers Eye Institute, Stanford University, Palo Alto, CA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA
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15
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Spelta S, Micera A, Gaudenzi D, Niutta M, Surico PL, De Vincentis A, Coassin M, Di Zazzo A. A Functional and Immunologic Point of View on Corneal Endothelial Transplantation: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3431. [PMID: 38929958 PMCID: PMC11204674 DOI: 10.3390/jcm13123431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: To systematically review and meta-analyze the immunologic aspects and outcomes of various endothelial keratoplasty (EK) techniques, specifically comparing Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK), Ultra-Thin Descemet's Stripping Automated Endothelial Keratoplasty (UT-DSAEK), and Descemet's Membrane Endothelial Keratoplasty (DMEK). Methods: Systematic review and meta-analysis. Main outcomes were the proportion of patients achieving a best spectacle-corrected visual acuity (BSCVA) of 20/20 at 6 months after keratoplasty, rejection rate one year after surgery, BSCVA at last follow up, and postoperative immunomodulating regimen. Results: A higher proportion of DMEK patients achieved a BSCVA of 20/20 after 6 months. UT-DSAEK and DMEK showed similar rejection rates with a lower risk of re-bubbling for UT-DSAEK (4% vs. 20%). Conclusions: DMEK showed faster visual recovery than UT-DSAEK but a similar rejection rate and long-term visual acuity. One-year postoperative slow tapering steroid regimen has a positive but not (yet) significant effect on rejection risk and visual outcomes.
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Affiliation(s)
- Sara Spelta
- Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy; (S.S.); (D.G.); (M.N.); (P.L.S.); (M.C.)
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS–Fondazione Bietti, 00184 Rome, Italy;
| | - Daniele Gaudenzi
- Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy; (S.S.); (D.G.); (M.N.); (P.L.S.); (M.C.)
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
| | - Matteo Niutta
- Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy; (S.S.); (D.G.); (M.N.); (P.L.S.); (M.C.)
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
| | - Pier Luigi Surico
- Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy; (S.S.); (D.G.); (M.N.); (P.L.S.); (M.C.)
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
| | - Antonio De Vincentis
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
- Internal Medicine, University Campus Bio-Medico, 00128 Rome, Italy
| | - Marco Coassin
- Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy; (S.S.); (D.G.); (M.N.); (P.L.S.); (M.C.)
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
| | - Antonio Di Zazzo
- Department of Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy; (S.S.); (D.G.); (M.N.); (P.L.S.); (M.C.)
- Fondazione Policlinico Campus Bio-Medico, 00128 Rome, Italy
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16
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Madsen MBM, Ivarsen A, Hjortdal J. Visual function after ultrathin Descemet's stripping automated endothelial keratoplasty or Descemet's membrane endothelial keratoplasty combined with cataract surgery: a randomised controlled clinical trial. Br J Ophthalmol 2024; 108:654-661. [PMID: 37290822 DOI: 10.1136/bjo-2023-323304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
AIMS To compare best-corrected visual acuity (BCVA), contrast sensitivity and endothelial cell density (ECD) after ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK). METHODS A randomised, single-blinded, single-centre design was used. 72 patients with Fuchs' endothelial dystrophy and cataract were randomised to UT-DSAEK or DMEK combined with phacoemulsification and lens implantation. 27 patients with cataract were included in a control group and treated with phacoemulsification and lens implantation. The primary outcome was BCVA at 12 months. RESULTS Compared with UT-DSAEK, DMEK resulted in better BCVA with mean differences of 6.1 early treatment diabetic retinopathy study (ETDRS) (p=0.001) after 3 months, 7.4 ETDRS (p<0.001) after 6 months and 5.7 ETDRS (p<0.001) after 12 months. The control group obtained significantly better BCVA with a mean difference of 5.2 ETDRS (p<0.001) compared with DMEK 12 months postoperatively. Compared with UT-DSAEK, contrast sensitivity was significantly better 3 months after DMEK with a mean difference of 0.10 LogCS (p=0.03). However, our study found no effect after 12 months (p=0.08). ECD was significantly lower after UT-DSAEK compared with DMEK with mean differences of 332 cells/mm2 (p<0.01) after 3 months, 296 cells/mm2 (p<0.01) after 6 months and 227 cells/mm2 (p=0.03) after 12 months. CONCLUSIONS Compared with UT-DSAEK, DMEK resulted in better BCVA 3, 6 and 12 months postoperatively. Twelve months postoperatively, DMEK had a higher ECD than UT-DSAEK; however, no difference in contrast sensitivity was found. TRIAL REGISTRATION NUMBER NCT04417959.
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Affiliation(s)
| | - Anders Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
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17
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Al-Kaabi A, Gustavson B, Alotaibi A, Aljohani A, Talajic J, Choremis J. Plastic vs. glass: the effect of the synthetic material in contact with DMEK tissue during staining on endothelial cell loss. Int Ophthalmol 2024; 44:139. [PMID: 38488945 DOI: 10.1007/s10792-024-03066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Endothelial cell loss (ECL) during Descemet membrane endothelial keratoplasty (DMEK) graft preparation has been shown to affect graft survival and the need for re-grafting. The purpose of this study was to quantitatively assess the impact of the plastic and glass mediums in contact with DMEK donor tissue during intra-operative graft staining on ECL. METHODS Retrospective study that included patients who underwent DMEK surgery between January 2019 and June 2021 at Hôpital Maisonneuve-Rosemont and the Jewish General Hospital in Montreal, Canada. DMEK grafts were stained with 0.06% Trypan blue ophthalmic solution (VisionBlue®, Dutch Ophthalmic, USA, Exeter, NH) for 120 s in either a plastic or glass medium prior to delivery into the recipient's eye. The ECL was compared between the two groups 12-30 months post-operatively. RESULTS ECL at 12-30 months was significantly less in the eyes that had received grafts stained in a plastic medium compared to those stained in a glass medium. Graft survival and re-bubbling was higher in the glass group however this difference was not statistically significant. CONCLUSION Staining of the DMEK graft in a plastic medium caused less ECL compared to the glass medium.
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Affiliation(s)
| | - Britta Gustavson
- Ophthalmology Department, University of British Columbia, Vancouver, BC, Canada
| | | | - Ayman Aljohani
- Ophthalmology Department, McGill University, Montreal, QC, Canada
| | - Julia Talajic
- Ophthalmology Department, Faculty of Medicine, University of Montreal, CP 6128, Center-Ville Branch, Montreal, QC, H3C 3J7, Canada
| | - Johanna Choremis
- Ophthalmology Department, McGill University, Montreal, QC, Canada.
- Ophthalmology Department, Faculty of Medicine, University of Montreal, CP 6128, Center-Ville Branch, Montreal, QC, H3C 3J7, Canada.
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18
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Parekh M, Wallace AG, Airaldi M, Ruzza A, Ferrari S, Romano V, Ahmad S. Performance outcomes from a DMEK peeling and preparation wet lab. BMJ Open Ophthalmol 2024; 9:e001540. [PMID: 38272533 PMCID: PMC10824027 DOI: 10.1136/bmjophth-2023-001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To evaluate the Descemet membrane endothelial keratoplasty (DMEK) preparation performance of trainee surgeons in an ex vivo human donor cornea DMEK wet lab simulation setting. METHODS Human donor corneoscleral rims unsuitable for transplantation were obtained from Moorfields Lions Eye Bank. At the wet lab, graft stripping was performed by scoring the peripheral endothelium. The trypan blue positive cells (TBPC) and cell density (cells/mm2-reticule count) were counted manually before and after stripping. The procedural time, peripheral and central tears and complete peel-off were also recorded and analysed. RESULTS Eight trainee surgeons attended the wet lab each attempting three DMEKs. Between the first and last attempts a significant decrease was seen in the procedural time (17.6 min vs 10.6 min (p<0.05)) and the TBPC % (12.9% vs 3.8% (p<0.05)). The percentage of tears peripherally and centrally also reduced between the first and the last trials (50% vs 13% (p=0.2226) and 38% vs 0% (p=0.1327)). A significant correlation was found between longer peeling times and higher TBPC % (p<0.001) with a 0.7% endothelial mortality increase for each additional minute required to complete the peel. CONCLUSIONS DMEK wet labs provide a controlled risk-free learning opportunity for trainee surgeons to improve confidence and competence. Wet labs improve the success rate of DMEK graft preparation as well as flatten the learning curve. This emphasises the importance of continued support for the expansion of this valuable learning resource, promoting wider uptake of DMEK surgery.
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Affiliation(s)
- Mohit Parekh
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Matteo Airaldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Stefano Ferrari
- Fondazione Banca degli Occi del Veneto, Mestre, Venice, Italy
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Straiko MMW, Sawant OB, Hubbs R, Dye PK, Tsering D, Hicks N, Odell K, Ellison MS, Titus MS, Straiko MD, Tran KD. Size and Shape Matter: Cell Viability of Preloaded Descemet Stripping Automated Endothelial Keratoplasty Grafts in Three Different Carriers. Cornea 2024; 43:111-119. [PMID: 37747694 DOI: 10.1097/ico.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The aim of this study was to examine endothelial cell loss (ECL) associated with preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) grafts loaded into 3 carriers of different size and shape. METHODS Thirty-six donor corneas were prepared for DSAEK and loaded into an EndoGlide Ultrathin (control) (2.0 mm × 3.5 mm lumen, 4.5 mm/4.9 mm incision for scleral tunnel/clear corneal insertion), Descemet membrane endothelial keratoplasty EndoGlide (experimental) (1.1 mm × 1.7 mm lumen, 2.65 mm incision), or round glass Jones tube (experimental) (1.8 mm lumen, 3.0 mm incision). Control grafts were stored for 6 days in Optisol-GS and experimental grafts stored for 24 hours in Life4C before analysis using Calcein AM staining. Grafts were imaged and ECL was analyzed by FIJI segmentation. The statistical significance of ECL was determined using 1-way ANOVA and Tukey post hoc analysis. RESULTS There were no significant differences in donor characteristics for grafts in each cohort. ECL for grafts loaded into the EndoGlide Ultrathin was 10.3% ± 2.3% (graft thickness: 60-189 μm, n = 9). ECL for grafts loaded into the Descemet membrane endothelial keratoplasty EndoGlide was 22.2% ± 7.1% (graft thickness: 38-63 μm, n = 9). ECL for thin grafts (34-60 μm, n = 9) loaded into the Jones tube was 24.0% ± 5.0%. ECL for thick grafts (92-119 μm, n = 9) loaded into the Jones tube was 34.2% ± 6.1% ECL ( P < 0.001). Combined regression analysis revealed that graft thickness is directly correlated to ECL ( P < 0.01). CONCLUSIONS The size and shape of the carrier can influence the cell viability of preloaded DSAEK grafts. Compared with a larger carrier, smaller lumen carriers are associated with greater ECL. In smaller lumen carriers, ECL increases with increasing DSAEK graft thickness.
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Affiliation(s)
| | - Onkar B Sawant
- Center for Vision and Eye Banking Research, Eversight, Cleveland, OH; and
| | | | | | | | - Nicholas Hicks
- Department of Clinical Operations, Eversight, Ann Arbor, MI
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20
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Roberts HW, Akram H, Davidson M, Myerscough J. Safety and clinical outcomes of omitting same and next day review after DMEK performed with an inferior peripheral iridotomy. Eye (Lond) 2023; 37:3492-3495. [PMID: 37185955 PMCID: PMC10630466 DOI: 10.1038/s41433-023-02542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND/OBJECTIVES To determine the incidence of day one postoperative complications after Descemet Membrane Endothelial Keratoplasty (DMEK) performed with intraoperative inferior peripheral iridotomy (PI), and whether their early detection influences postoperative intervention. SUBJECTS/METHODS 70 eyes of 70 consecutive patients that underwent DMEK from August 2019 to August 2021 at a single UK centre were retrospectively analysed. Cases that did not have an inferior PI were excluded. Any action taken at day one and week one postoperative review was noted. RESULTS No pupil block or other major adverse events were found at day one review. At one week, 14 eyes (20%) required re-bubbling, all of which had been fully attached at the day one review. CONCLUSIONS This series suggests that inferior PI performed alongside DMEK alone or triple DMEK effectively minimizes the risk of pupil block. Since no early complications occurred in this cohort requiring immediate intervention, it may be safe to defer review of these patients to a later time point.
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Affiliation(s)
- Harry W Roberts
- Eye Department, Southend University Hospital, Southend-on-Sea, SS0 0RY, UK.
- West of England Eye Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK.
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Haseeb Akram
- Eye Department, Southend University Hospital, Southend-on-Sea, SS0 0RY, UK
| | - Max Davidson
- Eye Department, Southend University Hospital, Southend-on-Sea, SS0 0RY, UK
| | - James Myerscough
- Eye Department, Southend University Hospital, Southend-on-Sea, SS0 0RY, UK
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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21
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Mishra S, Joshi A, Ginu P, Sati A, Kumar SV. Corneal transplantation: A walk to vision. Med J Armed Forces India 2023; 79:645-650. [PMID: 37981925 PMCID: PMC10654358 DOI: 10.1016/j.mjafi.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/19/2023] [Indexed: 11/21/2023] Open
Abstract
Corneal diseases are a major cause of blindness in the world. Corneal transplantation has been a cornerstone in the management of several of these advanced pathologies. This article discusses the evolution of corneal transplantation over a century, its indications, complications and briefly the various surgical techniques. Such tremendous technical improvisations from total corneal transplantation to lamellar keratoplasties have generated significant interest in the ophthalmic world and garnered momentum to the fight against blindness. Armed Forces Medical Services are also in vogue more than ever in this forward surge.
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Affiliation(s)
- S.K. Mishra
- Consultant & Head (Ophthalmology), Army Hospital (R & R), Delhi Cantt, India
| | - Amrita Joshi
- Graded Specialist (Ophthalmology), Army Hospital (R & R), Delhi Cantt, India
| | - P.M. Ginu
- Graded Specialist (Ophthalmology), Military Hospital Hisar, Hisar Cantt, India
| | - Alok Sati
- Senior Adviser (Ophthalmology), Army Hospital (R & R), Delhi Cantt, India
| | - Sonali V. Kumar
- Associate Professor (Ophthalmology), Army Hospital (R & R), Delhi Cantt, India
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Xiao G, Tsou BC, Soiberman US, Prescott CR, Srikumaran D, Woreta FA. Keratoplasty in the United States: Trends and Indications From 2015 to 2020. Cornea 2023; 42:1360-1364. [PMID: 36730420 DOI: 10.1097/ico.0000000000003180] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020. METHODS This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran-Armitage test. RESULTS The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160-15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%-27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%-33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%-1.2%, P < 0.001).From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%-11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively. CONCLUSIONS From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.
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Affiliation(s)
- Grace Xiao
- Johns Hopkins University School of Medicine, Baltimore, MD
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Parekh M, Ruzza A, Rovati M, Tzamalis A, Romano D, Gupta N, Vaddavalli P, Bhogal M, Jhanji V, Sawant O, Semeraro F, Ponzin D, Jacob S, Dragnea DC, Rodriguez-Calvo-de-Mora M, Dhubhghaill SN, Fogla R, Sharma N, Jurkunas UV, Ferrari S, Romano V. DMEK surgical training: An instructional guide on various wet-lab methods. Surv Ophthalmol 2023; 68:1129-1152. [PMID: 37392969 DOI: 10.1016/j.survophthal.2023.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplantation procedure that involves selective transplantation of the Descemet membrane and endothelium. DMEK offers significant advantages over other keratoplasty techniques, such as faster visual rehabilitation, better final visual acuity due to minimal optical interface effects, lower risk of allograft rejection, and less long-term dependence on topical steroids. Despite all its advantages, DMEK has been found to be more challenging than other corneal transplantation techniques, and its steep learning curve appears to be an obstacle to its widespread use and adoption by corneal surgeons worldwide. DMEK surgical training laboratories (wet labs) provide a window of opportunity for surgeons to learn, prepare, manipulate, and deliver these grafts in a risk-free environment. Wet labs are a significant learning tool, especially for those institutions that have limited tissue availability in their local centers. We provide a step-by-step guide for preparing DMEK grafts using different techniques on human and nonhuman models with instructional videos. This article should eventually help the trainees and the educators understand the requirements for performing DMEK and conducting a DMEK wet lab and develop their skills and interests from a wide variety of available techniques.
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Affiliation(s)
- Mohit Parekh
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Marco Rovati
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Davide Romano
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nidhi Gupta
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Pravin Vaddavalli
- Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Onkar Sawant
- Department of Research and Development, Center for Vision and Eye Banking Research, Eversight, Cleveland, OH, USA
| | - Francesco Semeraro
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Soosan Jacob
- Department of Cataract and Glaucoma Services, Dr. Agarwal's Refractive and Cornea Foundation, Chennai, India
| | | | | | | | - Rajesh Fogla
- Department of Ophthalmology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Namrata Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Ula V Jurkunas
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vito Romano
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Eye Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
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Double-Scroll Formation by Fluid Column Manipulation in Preloaded DMEK Grafts Prepared From Younger and Older Donor Tissue. Cornea 2023; 42:351-358. [PMID: 36255778 DOI: 10.1097/ico.0000000000003135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine whether manipulation of preloaded single-scroll Descemet membrane endothelial keratoplasty (DMEK) grafts within the fluid column of an injector can safely and reliably result in formation of double-scroll DMEK grafts and whether there are differential effects on younger versus older donor tissue. METHODS Pairs of DMEK grafts prepared from older (65-80 years) and younger (48-64 years) donors were preloaded into a Straiko modified Jones tube. One member of the pair was manipulated within the fluid column to form a double-scroll graft, and the other remained unmanipulated. Outcomes measured include success rate for double-scroll formation, endothelial cell loss (ECL), and relative scroll width. RESULTS Older donor grafts formed double scrolls with a 100% success rate. ECL of older donor manipulated grafts was statistically higher than that of unmanipulated mate grafts (17.4% ± 3.5% vs. 13.0% ± 4.2%, P = 0.03), but was still within the acceptable range for transplant. Younger donor grafts were successfully manipulated into double scrolls with a 67% success rate, and there was no difference in the ECL of manipulated and unmanipulated grafts (15.5% ± 4.4% vs. 13.0% ± 4.5%, P = 0.24). For all grafts and conformations, there was a significant relationship between relative scroll width and ECL ( P < 0.01). CONCLUSIONS Fluid column manipulation can be used reliably to form double-scroll DMEK grafts. For younger donor grafts, manipulation yields a double scroll without increasing ECL. For older donor grafts, manipulation results in a minimal, acceptable increase in ECL. Surgeons should weigh the advantage of an easily opened graft against the risk of increased ECL when considering this technique.
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Fenech MT, Coco G, Pagano L, Gadhvi KA, Titley M, Levis HJ, Parekh M, Kaye SB, Romano V. Thinning rate over 24 months in ultrathin DSAEK. Eye (Lond) 2023; 37:655-659. [PMID: 35292772 PMCID: PMC9998379 DOI: 10.1038/s41433-022-02011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022] Open
Abstract
AIM To describe the changes in corneal graft thickness following ultrathin Descemet's Stripping Automated Endothelial Keratoplasty (UT-DSAEK) comparing pre- and postoperative values over a 24-month period. METHODS In this retrospective single-center case series, patients who received eye bank-prepared tissues for UT-DSAEK surgery were included. Preoperative and postoperative graft thickness measurements were determined in the eye bank and in clinic using anterior segment optical coherence tomography (AS-OCT) images. Graft thickness measurements and their percentage change between preoperative values and values at 1 day, 1 week and 1, 6, 12, 24 months were calculated. RESULTS In total, 47 eyes of 47 patients with a mean age of 69 ± 11 years (29 males) were included. Twnty-three patients had Fuchs' endothelial dystrophy (49%) and the remaining 24 had pseudophakic bullous keratopathy (51%). In total, 29/47 eyes underwent UT-DSAEK alone (62%) and 18/47 received combined cataract surgery as a triple procedure (38%). Preoperative donor graft thickness was 92 ± 28 μm. Compared to preoperative values, where graft thickness increased to 194 ± 101.3 μm at 1 day, 151.1 ± 71.4 μm at 1 week, and 108.4 ± 52.5 μm at 1 month. Graft thickness continued to gradually decrease over time until 6 months (91.7 ± 33.6 μm), and then plateaued at 12 months (83.9 ± 25.0 μm), showing minimal changes at 2 years (101.4 ± 37.5 μm). CONCLUSION Preoperative DSAEK graft thickness measurements as reported by the eye bank are a valid approximation of DSAEK graft thickness at 6 months after surgery and these measurements tend to stabilize over time up to 2 years after surgery.
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Affiliation(s)
- Matthew T Fenech
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
| | - Giulia Coco
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Pagano
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK.
- Humanitas Clinical and Research Center, via Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Kunal A Gadhvi
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
| | - Mitchell Titley
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Institute of Ophthalmology, University College London, London, UK
| | - Stephen B Kaye
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
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Kalinnikov YY, Dinh THA, Zolotarevskiy AV, Kalinnikova SY. [A new surgical approach to pre-Descemet's endothelial keratoplasty]. Vestn Oftalmol 2023; 139:55-66. [PMID: 36924515 DOI: 10.17116/oftalma202313901155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
PURPOSE The study aimed to develop new surgical methods of obtaining and preserving pre-Descemet's endothelial keratoplasty (PDEK) graft in order to reduce the loss of donor material. MATERIAL AND METHODS The study was conducted on 30 sclerocorneal discs, which were divided into three groups. The first group consisted of 10 sclerocorneal discs to which the standard PDEK graft preparation technique was applied. The second group consisted of 10 sclerocorneal discs, where the PDEK graft preparation was done using the optimized method 1 involving the KD Ring fixator, KD Base for PDEK, KD-30G needle with 5 mL syringe connected to the spring-load plunger, a preservative solution. The third group consisted of 10 sclerocorneal discs with PDEK graft prepared using the optimized method 2, which differed from the optimized method 1 in additional use of the KD artificial chamber for PDEK. When successfully acquiring the type-1 "big bubble", the dissected PDEK graft was preserved for further use in clinical practice using our own technique. RESULTS In the first group, formation of the type-1 «big bubble» was achieved only in 5 out of 10 donor corneas (50%). Bubble ruptures happened in 4 cases (40%) and type-2 «big bubble» occurred in 1 case (10%). In the second group (optimized method 1) the type-1 «big bubble» was achieved in 9 cases (90%), while in the third group (optimized method 2) the type-1 «big bubble» was achieved in 10 cases (100%), proving the effectiveness of our PDEK graft preparation technique. CONCLUSION We presented a novel surgical approach for acquiring and preserving PDEK graft that minimizes almost all the difficulties that surgeons face, including bubble rupture during pneumodissection and hydrodissection, formation of type-2 and mixed type bubble, and obtaining a PDEK graft of the required size; the details of the surgical technique have been refined. The proposed technique for graft preparation and preservation can be easily implemented in eye banks and is convenient for clinical practice.
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Affiliation(s)
- Yu Yu Kalinnikov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - T H A Dinh
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Vietnam National Eye Hospital, Hanoi, Vietnam
| | | | - S Yu Kalinnikova
- S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery»», Moscow, Russia
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Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium Inward: A 24-Month Comparative Analysis Between Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy. Cornea 2022:00003226-990000000-00121. [PMID: 36538420 DOI: 10.1097/ico.0000000000003138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare long-term clinical outcomes of preloaded Descemet membrane endothelial keratoplasty (DMEK) between Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK). METHODS In this single-center retrospective clinical case series, 71 eyes of 64 patients indicated with FECD (62%) or BK (38%) (with or without cataract) were treated with preloaded DMEK grafts between March 2018 and February 2020. Standard DMEK peeling, followed by manual folding of the tissue with endothelium-inward orientation and storing in a preloaded fashion inside a 2.2-mm intraocular lens cartridge. All tissues were delivered using a bimanual pull-through technique, followed by air tamponade. Graft unfolding time, endothelial cell loss, corrected distance visual acuity, central corneal thickness, rebubbling rate, and intraoperative and postoperative complications at 1, 3, 6, 12, and 24 months were recorded. RESULTS The mean intraoperative graft unfolding time in FECD did not differ from the BK group ( P = 0.6061). Cystoid macular edema did not differ in either group ( P = 0.6866). The rebubbling rate was found to be significantly higher in FECD compared with the BK group ( P = 0.0423). Corrected distance visual acuity significantly improved at the first month after surgery ( P = 0.0012), with no differences between FECD and BK at 24 months ( P = 0.2578). Central corneal thickness was stable postoperatively and showed no differences between the groups ( P = 0.3693). Significantly higher endothelial cell counts were observed in the FECD group at 24 months ( P = 0.0002). CONCLUSIONS Preloaded DMEK with "endothelium-in" offers acceptable intraoperative time, rebubbling rate, and clinical outcomes in both FECD and BK groups. Patients with FECD show better postoperative clinical outcomes even if the rebubbling rate is relatively high.
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28
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Guindolet D, Disegni H, Martin GC, Azar G, Hardy S, Cochereau I, Gabison EE. Predictive factors of graft detachment and rebubbling after descemet membrane endothelial keratoplasty. Int Ophthalmol 2022; 43:1511-1521. [PMID: 36463376 DOI: 10.1007/s10792-022-02547-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE To identify risk and predictive factors associated with the need of rebubbling in the eye of patients who underwent a descemet membrane endothelial keratoplasty (DMEK). METHODS The records of patients who underwent DMEK were retrospectively analyzed. Data regarding comorbidities, intraoperative characteristics, and postoperative treatments or complications were collected. The central corneal thickness (CCT) was measured by optical coherence tomography before and the day after DMEK. Univariate and multivariate analyses were performed. RESULTS Of the 333 DMEK, rebubbling was performed in 119 cases (36%). Preoperative subepithelial fibrosis and a history of penetrating keratoplasty (PK) were associated with significantly more graft detachment [OR of 3.55 (2.02-6.32; P < 0.001) and 5.89 (2.00-21.86; P = 0.003), respectively]. A decreased CCT the day after surgery reduced by 5.7-fold the risk of rebubbling (sensitivity/specificity of 0.42/0.93). Conversely, a 20% increase in the CCT the day after surgery increased by 4.5-fold the risk of rebubbling (sensitivity/specificity of 0.42/0.91). CONCLUSION Variation of the CCT could be used as a predictive factor of rebubbling after DMEK. Patients with a 20% increase of CCT the day after surgery are at higher risk of graft detachment. Conversely, a reduced CCT the day after the surgery is associated with a reduced risk of rebubbling. Subepithelial fibrosis and history of PK were also identified as risk factors for rebubbling. Those predictive factors may help develop a customized approach for patients undergoing DMEK surgery.
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29
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Özkan B, Koçluk Y, Kasım B. Effects of Systemic Diseases on Graft Preparation in Descemet Membrane Endothelial Keratoplasty. Eye Contact Lens 2022; 48:527-533. [PMID: 36201646 DOI: 10.1097/icl.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the effects of the systemic diseases and drugs of the donor on Descemet membrane (DM) graft preparation. METHODS Seventy-eight corneas of 58 donors, of whom the DM grafts were used in Descemet membrane endothelial keratoplasty (DMEK) surgery, between January 2018 and January 2020, were enrolled in this retrospective study. The hospital records of the donors were analyzed. Age, sex, blood type, systemic diseases, and drugs; complete blood count; biochemistry panel for liver and kidney functions in the past 48 hours; and the drugs used in the hospital, if any, in the past 24 hours were recorded. The grafts with tears that occurred while preparation were included in group 1, and the successful grafts with no tears were included in group 2. RESULTS There were no statistically significant differences in the characteristics of the donors between groups. However, breast cancer and the use of sevelamer were found to be significantly higher in group 1 ( P =0.010, P =0.033, respectively). No statistically significant difference in the use of other drugs was found between groups. CONCLUSION Although diabetic donors have been reported to be inappropriate candidates for the preparation of DM grafts for DMEK, most of the donors with several systemic diseases including diabetes can be used in DMEK surgery, with the right technique in DM graft preparation.
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Affiliation(s)
- Burak Özkan
- Department of Ophthalmology (B.Ö.), Erciş Şehit Rıdvan Çevik State Hospital, Van, Turkey; and Department of Ophthalmology (Y.K., B.K.), Adana City Training and Research Hospital, Adana, Turkey
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Mandal S, Asif MI, Maharana PK, Sharma N, Titiyal JS. A review of techniques and outcomes of endothelial keratoplasty in congenital hereditary endothelial dystrophy. Indian J Ophthalmol 2022; 70:4108-4117. [PMID: 36453297 PMCID: PMC9940565 DOI: 10.4103/ijo.ijo_1313_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Congenital hereditary endothelial dystrophy affects the Descemet membrane and endothelium, resulting in corneal decompensation. Penetrating keratoplasty (PKP) has been the gold-standard surgical management until recently; however, at present, endothelial keratoplasty (DSEK/DSAEK/n-DSEK: Descemet-stripping or non-Descemet stripping endothelial keratoplasty and DMEK/n-DMEK: Descemet membrane endothelial keratoplasty) is being preferred due to lesser intraoperative and postoperative complications, early visual recovery, and comparable visual outcomes. Endothelial keratoplasty (EK) can be challenging, especially in pediatric eyes with CHED due to smaller eyeballs, shallow anterior chambers, phakic status, and poor intraoperative visibility due to thick and hazy corneas. A total of 198 articles matched our search strategy. After screening for duplication and going through the titles and abstracts, 12 relevant original articles, one case series, and six case reports were included in this review. Various surgical modifications have to be adopted in comparison to adult eyes to overcome the aforementioned difficulties. Regardless, studies have shown favorable visual outcomes with better graft survival and fewer complications in eyes that underwent EK compared to PKP. Hence, timely surgical intervention and strict amblyopia management can result in better final visual outcomes. The purpose of this review is to summarize various intraoperative difficulties and the surgical modifications required, different surgical techniques, visual and graft-related outcomes, and various complications of EK in CHED eyes.
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Affiliation(s)
- Sohini Mandal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed I Asif
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Dr. Namrata Sharma, Professor of Ophthalmology, Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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31
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Surgical Advancements in Corneal Transplantation. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Basak SK, Basak S, Gajendragadkar N. Outcomes of Descemet Membrane Endothelial Keratoplasty Using Cornea From Elderly Donors Aged 80 Years and Older: In the Aftermath of Current Donor Shortage. Cornea 2022; 41:1437-1443. [PMID: 34743100 DOI: 10.1097/ico.0000000000002902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) using corneas from elderly donors aged 80 years and older. METHODS Eighty eyes of 78 patients who underwent DMEK-only or DMEK combined with cataract extraction (triple-DMEK) with surgeon-prepared graft between April 2016 and March 2020 were reviewed. Corrected distance visual acuity, endothelial cell density (ECD), and endothelial cell loss after 6 months, 1 year, and 2 years were analyzed. RESULTS The mean donor age was 83.6 ± 3.7 years (range: 80-100 years), and the mean donor ECD was 2889 ± 177 cells/mm 2 (range: 2604-3460 cells/mm 2 ). The mean recipient age was 67.2 ± 6.9 years (range: 60-89 years), and the mean follow-up was 21 ± 11 months (range: 6-52 months). The mean corrected distance visual acuity improved from a preoperative value of 1.36 ± 0.67 logarithm of the minimum angle of resolution to 0.22 ± 0.18 at 6 months (n = 75), 0.21 ± 0.2 at 1 year (n = 64), and 0.23 ± 0.3 logarithm of the minimum angle of resolution at 2 years (n = 41), respectively ( P < 0.001). In 72 eyes (96%), the graft remained transparent until the last follow-up visit. The mean postoperative ECD was 2073 ±336 (n = 75), 1951 ± 379 (n = 65), and 1807 ± 431 cells/mm 2 (n = 41) at 6 months, 1 year, and 2 years, respectively. Five eyes (6.7%) had donor detachments of which 4 required rebubbling. Two grafts failed after 1 year, and 2 eyes (2.6%) had graft rejection, of which 1 eye was reverted successfully by medical management. CONCLUSIONS Cornea from elderly donors aged 80 years and older with good selection criteria may be considered for DMEK with successful outcomes. For India and other countries with unmet tissue needs, every best single cornea counts.
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Affiliation(s)
- Samar K Basak
- Cornea Department, Disha Eye Hospitals, Barrackpore, Kolkata, India
- Prova Eye Bank, BC Memorial Eye Foundation, Barrackpore, Kolkata, India; and
| | - Soham Basak
- Cornea Department, Disha Eye Hospitals, Barrackpore, Kolkata, India
| | - Nidhi Gajendragadkar
- Cornea Department, Disha Eye Hospitals, Barrackpore, Kolkata, India
- Kashyap Memorial Eye Hospital, Ranchi, Jharkhand, India
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Descemet Stripping Automated Endothelial Keratoplasty in Thick Corneas. J Clin Med 2022; 11:jcm11195601. [PMID: 36233466 PMCID: PMC9572918 DOI: 10.3390/jcm11195601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/02/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the outcomes of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in corneas > 820 microns in thickness. Methods: This retrospective study included 30 eyes of 30 patients who underwent DSAEK. Endothelial cell destiny (ECD) and corneal thickness were recorded before surgery and at 1 and 12 months postoperatively. Patients were divided into two groups (≤ 820 microns and > 820 microns) based on median preoperative corneal thickness. Linear regression analyses were used to investigate the correlations between ECD and preoperative corneal thickness. Results: Recipient corneal thickness (RCT) and postoperative central cornea thickness had a statistically significant difference 1 month after surgery (p = 0.03, p = 0.08, respectively). BCVA and ECD did not have a statistical difference in the two groups at 1 month and 12 months after DSAEK. Conclusions: BCVA, ECD and corneal thickness were similar at 12 months after DSAEK in thick corneas. DSAEK is a viable surgical option in thick corneas.
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34
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Singh P, Sinha A, Nagpal R, Chaurasia S. Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 2022; 70:3222-3238. [PMID: 36018091 DOI: 10.4103/ijo.ijo_2933_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is the closest to the physiological replacement of endothelial cells. In the initial years, the technique was surgically challenging. Over the years, with better understanding and modifications in the surgical steps, the technique has evolved as an alternative to more popular procedure Descemet stripping endothelial keratoplasty. The article highlights the various preoperative, intraoperative, and postoperative nuances of DMEK. Additionally, it summarizes the various comparative and noncomparative studies on DMEK outcomes.
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Affiliation(s)
- Prabhakar Singh
- Department of Cornea and Anterior Segment, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Akanksha Sinha
- Cornea and Anterior Segment, Sankara Eye Hospital, Kanpur, Uttar Pradesh, India
| | - Ritu Nagpal
- Research Officer, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Ong HS, Htoon HM, Ang M, Mehta JS. “Endothelium-Out” and “Endothelium-In” Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Insertion Techniques: A Systematic Review With Meta-Analysis. Front Med (Lausanne) 2022; 9:868533. [PMID: 35775001 PMCID: PMC9237218 DOI: 10.3389/fmed.2022.868533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated the visual outcomes and complications of “endothelium-out” and “endothelium-in” Descemet membrane endothelial keratoplasty (DMEK) graft insertion techniques. Materials and Methods Electronic searches were conducted in CENTRAL, Cochrane databases, PubMed, EMBASE, ClinicalTrials.gov. Study designs included clinical trials, comparative observational studies, and large case series (≥25 eyes). PRISMA guidelines were used for abstracting data and synthesis. Random-effects models were employed for meta-analyses. Results 21,323 eyes (95 studies) were included. Eighty-six studies reported on “endothelium-out” techniques; eight studies reported on “endothelium-in” techniques. One study compared “endothelium-out” to “endothelium-in” techniques. Eighteen “endothelium-out” studies reported that 42.5–85% of eyes achieved best-corrected visual acuity (BCVA) ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 58.7% (95% CI 49.4–67.7%,15 studies). Three “endothelium-in” studies reported that 44.7–87.5% of eyes achieved BCVA of ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 62.4% (95% CI 33.9–86.9%). Pooled mean endothelial cell loss was lower in the “endothelium-in” studies (28.1 ± 1.3%, 7 studies) compared to “endothelium-out” studies (36.3 ± 6.9%,10 studies) at 6 months (p = 0.018). Graft re-bubbling rates were higher in the “endothelium-out” studies (26.2%, 95% CI 21.9–30.9%, 74 studies) compared to “endothelium-in” studies (16.5%, 95% CI 8.5–26.4%, 6 studies), although statistical significance was not reached (p = 0.440). Primary graft failure rates were comparable between the two groups (p = 0.552). Quality of evidence was considered low and significant heterogeneity existed amongst the studies. Conclusion Reported rates of endothelial cell loss were lower in “endothelium-in” DMEK studies at 6 months compared to “endothelium-out” studies. Outcomes of “endothelium-in” techniques were otherwise comparable to those reported in “endothelium-out” studies. Given the technical challenges encountered in “endothelium-out” procedures, surgeons may consider “endothelium-in” techniques designed for easier intra-operative DMEK graft unfolding. “Endothelium-in” studies evaluating outcomes at longer time points are required before conclusive comparisons between the two techniques can be drawn.
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Affiliation(s)
- Hon Shing Ong
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Hon Shing Ong,
| | - Hla M. Htoon
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Ang
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Jodhbir S. Mehta,
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Efficacy of Thin and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Influence of Graft Thickness on Postoperative Outcomes: Systematic Review and Meta-analysis. Am J Ophthalmol 2022; 240:170-186. [PMID: 35346623 DOI: 10.1016/j.ajo.2022.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the efficacy of thin and ultrathin Descemet stripping automated endothelial keratoplasty (T-DSAEK and UT-DSAEK, with graft thickness <130 and <100 µm, respectively), depending on graft thickness. DESIGN Systematic review and meta-analysis. METHOD PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and ScienceDirect databases were searched until October 1, 2021. We computed random-effect meta-analysis on postoperative outcomes of T/UT-DSAEK, stratified by graft thickness (<80 μm, 80-100 μm, and 100-130 μm). The main postoperative outcome was visual acuity (logarithm of the minimum angle of resolution [logMAR]). Secondary outcomes were pachymetry (μm), endothelial cell count (cell/mm2), spherical equivalent (diopter [D]), rebubbling rate (%), and rejection rate (%). Meta-regressions compared postoperative outcomes depending on graft thickness and search for putative confusion factors. RESULTS We included 47 articles for a total of 2141 eyes of 2040 patients. T/UT-DSAEK globally improved visual acuity (effect size = -0.38 logMAR [95% confidence interval {CI} -0.46 to -0.30 logMAR]), without difference depending on graft thickness. Overall, pachymetry improved (-60.6 µm [95% CI -101 to -19.7 µm]), endothelial cell count decreased (-1039 cells/mm2 [95% CI -1209 to -868 cells/mm2), spherical equivalent resulted in a hyperopic shift (0.74 D [95% CI -0.50 to 1.97 D), the graft rejection rate was 0.2% (95% CI -0.1% to 0.4%), and the rebubbling rate was 8.7% (95% CI 6.8%-10.5%). Grafts >100 μm induced a hyperopic shift. Metaregressions did not demonstrate differences between the 3 groups (<80 μm, 80-100 μm, or 100-130 μm) in any outcomes. CONCLUSION All T/UT-DSAEK thickness groups provided similar visual acuity, pachymetry, endothelial cell count, rejection rate, and rebubbling rate regardless of graft thickness. A hyperopic shift was induced by grafts >100 μm.
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Liu S, Wong YL, Walkden A. Current Perspectives on Corneal Transplantation. Clin Ophthalmol 2022; 16:631-646. [PMID: 35282172 PMCID: PMC8904759 DOI: 10.2147/opth.s289359] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 12/18/2022] Open
Abstract
Disease of the cornea is the third leading cause of blindness worldwide. Corneal graft surgery is one of the most successful forms of solid organ transplantations in humans, with ever-increasing developments in surgical technique. To date, approximately 4504 corneal transplants are performed in the United Kingdom each year. While full thickness transplantation was the most commonly performed keratoplasty over the last few decades, selective lamellar transplantation of the diseased layers of the cornea has been universally adopted. This comprehensive review aims to provide an updated synthesis on different types of corneal transplantations, their treatment outcomes, and the associated complications of each procedure in both adult and paediatric population. In addition, we also present an up-to-date summary of the emerging therapeutic approaches that have the potential to reduce the demand for donor-dependent keratoplasty.
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Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yee Ling Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Correspondence: Andrew Walkden, Email
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Roberts HW, Kit V, Phylactou M, Din N, Wilkins MR. 'Posture-Less' DMEK: Is Posturing After Descemet Membrane Endothelial Keratoplasty Actually Necessary? Am J Ophthalmol 2022; 240:23-29. [PMID: 35227697 DOI: 10.1016/j.ajo.2022.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the clinical results of Descemet membrane endothelial keratoplasty (DMEK) without any intraoperative or postoperative posturing. DESIGN Retrospective, noncomparative, and interventional case series. METHODS One hundred thirty-four (134) consecutive eyes of 101 patients requiring DMEK for any cause of endothelial failure were included. Descemet membrane endothelial keratoplasty was performed with an intraoperative inferior PI. After unscrolling and centration of the graft, the anterior chamber was near completely filled with 20% SF6. After filling the eye with gas there was no intraoperative tamponade time, and patients did not posture postoperatively. Main outcome measures were: graft detachment rate, rebubbling rate, primary and secondary failure rates, rejection rate, intraoperative and postoperative complications, and visual acuity 3 and 12 months after surgery. RESULTS Five of 134 (3.7%) developed graft detachment greater than one-third of the graft area, and 19 of 134 (14.2%) developed graft detachment less than one-third of the graft area. A rebubble procedure was performed in 19 of 134 (14.2%); of those, the average number of rebubbling procedures performed was 1.13 (range, 1-2). Primary failure occurred in 6 of 134 (4.5%).Twelve-month graft survival occurred in 122 of 134 eyes (91.0%), with secondary failure within the first 12 months accounting for failure of 6 of 134 (4.5%). Nine of 134 (6.7%) cases had a recorded episode of endothelial rejection. The average time for rejection episode was 9.5 months (range, 1-20 months) after surgery. CONCLUSIONS A total of 134 'posture-less' DMEKs did not suffer very high rates of graft detachment, rebubbling, or other postoperative complications, even with immediate erect posturing after surgery.
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Affiliation(s)
- Harry W Roberts
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W).
| | - Vivienne Kit
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W); UCL Institute of Ophthalmology, London, United Kingdom (V.K, M.R.W)
| | - Maria Phylactou
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W)
| | - Nizar Din
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W)
| | - Mark R Wilkins
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W); UCL Institute of Ophthalmology, London, United Kingdom (V.K, M.R.W)
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Weisenthal RW, Yin HY, Jarstad AR, Wang D, Verdier DD. Long-term Outcomes in Fellow Eyes Comparing DSAEK and DMEK for Treatment of Fuchs Corneal Dystrophy. Am J Ophthalmol 2022; 233:216-226. [PMID: 34157279 DOI: 10.1016/j.ajo.2021.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the long-term results of Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) in fellow eyes for treatment of Fuchs endothelial corneal dystrophy. METHODS This study is a 2-centered, retrospective case series of 64 patients (128 eyes) with DSAEK followed by DMEK. The main outcomes measured were best spectacle-corrected visual acuity (BSCVA) and duration of time to achieve BSCVA as well as eye preference. RESULTS Preoperative median logarithm of the minimum angle of resolution (logMAR) BSCVA was similar in eyes receiving DMEK 0.36 ± 0.26 and DSAEK 0.42 ± 0.34 (P = .266). The average follow-up time needed for the DMEK eyes to achieve BSCVA was faster than that of DSAEK (277 days vs 490 days, P = .0014). With long-term follow-up, the BSCVA of the DMEK eyes [0.09 ± 0.10 logMAR] and DSAEK eyes [0.11 ± 0.16 logMAR] did not show a statistically significant difference (P = .069). Twenty-two of the 64 preferred the DMEK eye, 17 patients preferred the DSAEK eye (P = .423), and 25 patients did not have a preference. In the DMEK group, the average spherical equivalent was -0.08 compared with the DSAEK group at 0.06 (P = .2854). CONCLUSION In our fellow eye study with long-term follow-up, DMEK and DSAEK had comparable levels of BSCVA and patient satisfaction. The DMEK eyes reached their BSCVA sooner, whereas the DSAEK eyes improved over a longer time frame. A greater number of patients had 20/25 and 20/20 vision in the DMEK group; however, the difference was not statistically significant. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Robert W Weisenthal
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York.
| | - Han Y Yin
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Allison R Jarstad
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York
| | - Dongliang Wang
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York
| | - David D Verdier
- Department of Surgery, Ophthalmology Division Michigan State University College of Human Medicine Eye Grand Rapids Michigan Verdier Center, Grand Rapid, Michigan, USA
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Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes. J Clin Med 2021; 10:jcm10215119. [PMID: 34768639 PMCID: PMC8584974 DOI: 10.3390/jcm10215119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The need to provide a comparative analysis of corneal parameter changes compared to their preoperative values between Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) patients. Methods: The study included 24 eyes after UT-DSAEK and 24 eyes after DMEK. Visual acuity, endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA) and higher-order aberrations (HOAs) were assessed at baseline and 1, 3, 6 and 12 months after the surgery. Results: From the 3rd month post operation, ECC was higher in the DMEK eyes than in the UT-DSAEK eyes (p = 0.01). In a bivariate analysis that was adjusted for age, DMEK was associated with a smaller decrease in posterior MK at the 1-month (β = −0.49, p = 0.002), 3-month (β = −0.50, p < 0.001), 6-month (β = −0.58, p < 0.001) and 12-month (β = −0.49, p < 0.001) follow-up visits. There were no significant differences in changes in anterior or combined surface MK throughout the observation period. Accordingly, no significant differences in changes in MA, AA or HOAs compared to the baseline values were identified between the eyes after DMEK and UT-DSAEK at any follow-up time point. Conclusions: UT-DSAEK seemed to be an easier and safer technique than DMEK while maintaining similar outcomes regarding irregular astigmatism and total keratometry values.
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Alshaker S, Mimouni M, Batawi H, Cohen E, Trinh T, Santaella G, Chan CC, Slomovic AR, Rootman DS, Sorkin N. Four-Year Survival Comparison of Endothelial Keratoplasty Techniques in Patients With Previous Glaucoma Surgery. Cornea 2021; 40:1282-1289. [PMID: 33332901 DOI: 10.1097/ico.0000000000002585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare 4-year survival outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma surgery. METHODS This is a retrospective, comparative case series, including patients with previous trabeculectomy or glaucoma drainage device implantation, who later underwent either DMEK (n = 48) or DSAEK (n = 41). Follow-up was limited to 12 to 60 months to prevent bias. Primary outcomes were graft survival and rejection. Secondary outcomes were best spectacle-corrected visual acuity (BSCVA), detachment/rebubble, endothelial cell loss, and intraocular pressure elevations. RESULTS Baseline characteristics, follow-up duration, and preexisting glaucoma parameters did not differ significantly between the groups. Graft survival probability after DMEK and DSAEK was 75% and 75% at 1 year, 63% and 50% at 2 years, 49% and 44% at 3 years, 28% and 33% at 4 years, and 28% and 29% at 5 years, respectively (P = 0.899 between the groups). Graft rejection rates were 20.8% and 19.5%, respectively (P = 1.000). Primary failure, rebubbling, endothelial cell loss, and intraocular pressure elevation did not differ significantly between the groups. Preoperative BSCVA did not differ between the groups (P = 0.821). Postoperative BSCVA was significantly better in the DMEK group at 6, 12, and 24 months (P < 0.001, P = 0.022, and P = 0.047, respectively). In a multivariable model (R2 = 0.576), the type of surgery was the only significant factor affecting postoperative BSCVA, in favor of DMEK (coefficient value -0.518, P = 0.002). CONCLUSIONS In eyes with previous glaucoma surgery, DMEK and DSAEK had comparably low survival and comparably high rejection rates. Postoperative visual acuity might be better after DMEK in this setting.
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Affiliation(s)
| | | | | | - Eyal Cohen
- University of Toronto, Toronto, Canada; and
| | | | | | | | | | | | - Nir Sorkin
- University of Toronto, Toronto, Canada; and
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Adler A, Rozanes E, Ciechanowski P, Nahum Y, Graffi S, Elbaz U, Bahar I, Livny E. Outcomes of Repair of Total Graft Detachment following Descemet's Membrane Endothelial Keratoplasty. Klin Monbl Augenheilkd 2021; 238:1236-1239. [PMID: 34528228 DOI: 10.1055/a-1533-2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To present the outcomes of attempts to salvage total graft detachment following Descemet's membrane endothelial keratoplasty (DMEK). METHODS A search of the electronic medical records of two tertiary medical centers for all patients who underwent DMEK yielded six cases of postoperative total graft detachment (2.54%). Graft salvage was attempted in all cases using repeated intracameral graft staining, unfolding, and reattachment to the stroma under 20% hexafluoride gas. RESULTS In all cases, a free-floating totally detached graft was identified in the anterior chamber shortly after surgery. Salvage surgery resulted in a central, well-oriented, and fully attached graft. In three cases, the primary graft failed, and in two, the corneas cleared at first but failed after 2 months and 1 year respectively. In one case, the cornea remained clear during 1 year of follow-up but had a very low endothelial cell density. CONCLUSION Reattachment of fully detached DMEK graft is technically possible, but graft manipulation during the primary and secondary operations is likely to damage the endothelial cells, resulting in primary or early graft failure. If graft salvage is attempted, the probability of primary or early graft failure should be discussed with the patient, and expectations should be tempered accordingly.
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Affiliation(s)
- Avital Adler
- Ophthalmology, Rabin Medical Center, Ophthalmology Division - Beilinson and Hasharon, Petah Tikva, Israel.,Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eliane Rozanes
- Ophthalmology, Rabin Medical Center, Ophthalmology Division - Beilinson and Hasharon, Petah Tikva, Israel
| | - Peter Ciechanowski
- Augenarzt und Augenchirurgie, Privatklinik - Augenzentrum Dietikon, Zürich, Schweiz
| | - Yoav Nahum
- Ophthalmology, Rabin Medical Center, Ophthalmology Division - Beilinson and Hasharon, Petah Tikva, Israel.,Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shmuel Graffi
- Department of Ophthalmology, Rambam Hospital, Haifa, Israel.,Medicine, Technion Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Uri Elbaz
- Ophthalmology, Rabin Medical Center, Ophthalmology Division - Beilinson and Hasharon, Petah Tikva, Israel.,Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Irit Bahar
- Ophthalmology, Rabin Medical Center, Ophthalmology Division - Beilinson and Hasharon, Petah Tikva, Israel.,Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eitan Livny
- Ophthalmology, Rabin Medical Center, Ophthalmology Division - Beilinson and Hasharon, Petah Tikva, Israel.,Medicine, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Matsou A, Pujari R, Sarwar H, Rana M, Myerscough J, Thomson SM, Nandakumar G, Zhang J, Rajan MS. Microthin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty: A Randomized Clinical Trial. Cornea 2021; 40:1117-1125. [PMID: 33156076 DOI: 10.1097/ico.0000000000002601] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare visual outcomes, complications, and vision-related quality of life (QoL) after microthin Descemet stripping automated endothelial keratoplasty (MT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) for the management of corneal endothelial dysfunction in Fuchs dystrophy. METHODS This is a prospective, double-blinded randomized controlled clinical trial. Patients with visually significant endothelial decompensation from Fuchs dystrophy were prospectively randomized to receive MT-DSAEK or DMEK surgery. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 12 months. Secondary outcomes included refraction, keratometry, endothelial cell count, complications, and vision-related QoL at 6 and 12 months postoperatively. RESULTS A total of 56 eyes of 56 patients were enrolled, 28 in each group. Postoperatively, LogMAR mean BSCVA in the MT-DSAEK group was 0.17 ± 0.08 and 0.11 ± 0.09 at 6 and 12 months compared with 0.09 ± 0.13 and 0.04 ± 0.13 after DMEK (P = 0.03, P = 0.002 respectively) with the DMEK cohort achieving 3.5 logarithm of the minimum angle of resolution letters better BSCVA at 1 year compared with MT-DSAEK. Complication rates were similar with 3.5% rebubbling rate in both groups, 1 primary graft failure in DMEK and a single endothelial rejection in the MT-DSAEK arm. Vision-related QoL was comparable at 6 and 12 months postoperatively, and no eyes demonstrated loss of vision from preoperative BSCVA. CONCLUSIONS DMEK surgery resulted in significantly better BSCVA at 1, 3, 6, and 12 months postoperatively compared with MT-DSAEK. Patient satisfaction was similar with no differences reported in vision-related QoL scores, as was the complications profile between groups. Thus, our results favor DMEK as the better choice procedure for eyes with Fuchs-related corneal decompensation without ocular comorbidities.
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Affiliation(s)
- Artemis Matsou
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - Rathin Pujari
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - Hammad Sarwar
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - Mrinal Rana
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - James Myerscough
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - Susan M Thomson
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - Girinath Nandakumar
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
| | - Jufen Zhang
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Madhavan S Rajan
- Department of Ophthalmology, Cambridge University Hospitals and Cambridge Eye Research Centre, Cambridge, UK; and
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
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Ex Vivo Safety and Efficacy of Paired Peripheral Incisions in Descemet's Membrane Endothelial Keratoplasty Grafts to Facilitate Unscrolling. Cornea 2021; 40:99-106. [PMID: 32769677 DOI: 10.1097/ico.0000000000002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the ex vivo safety and efficacy of using paired peripheral incisions to achieve a triple scroll conformation that facilitates unscrolling in Descemet membrane endothelial keratoplasty (DMEK). METHODS The safety of adding paired peripheral incisions to DMEK grafts was evaluated by assessing endothelial cell loss (ECL) and risk of tearing. ECL was measured using calcein-AM staining after incisions. The risk of tearing was evaluated by comparing incision lengths before and after simulated DMEK surgery using cadaveric eyes. Efficacy was evaluated by comparing the scrolling pattern and the width of grafts with different incision lengths (0.0 mm, 0.5 mm, and 1.0 mm). Surgical unscrolling times in simulated DMEK surgery by a novice DMEK surgeon were evaluated to determine whether incisions facilitate unscrolling in DMEK surgery. RESULTS The mean ECL after adding incisions was 0.78% ± 0.23%. There was no significant change in incision length after simulated DMEK surgery (P = 0.6). In donor grafts aged less than or equal to 65 years, 60% (6/10) achieved a stable triple scroll with 0.5 mm incisions and 80% (8/10) achieved a stable triple scroll with 1.0 mm incisions. In donor grafts aged greater than 65 years, 0% (0/4) achieved a stable triple scroll. Mean graft width increased significantly after forming a triple scroll (5575 μm ± 1128 μm) compared with baseline (1563 μm ± 428 μm) (P < 0.001). In the hands of a novice DMEK surgeon, the mean unscrolling time was significantly shorter with incisions (2.61 min ± 1.41 min) versus without incisions (5.44 min ± 3.17 min) (P = 0.02). CONCLUSIONS Paired peripheral incisions are safe and effective for inducing a triple scroll in DMEK grafts with donor age less than or equal to 65 years. Adding incisions may facilitate unscrolling for inexperienced DMEK surgeons.
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Lower Corneal Haze and Aberrations in Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty in Fellow Eyes for Fuchs Endothelial Corneal Dystrophy. Cornea 2021; 39:1227-1234. [PMID: 32639312 DOI: 10.1097/ico.0000000000002416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the long-term corneal changes in patients with Fuchs endothelial corneal dystrophy contributing to superior postoperative visual outcomes after Descemet membrane endothelial keratoplasty (DMEK) compared with Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS Using retrospective analysis, we evaluated 9 patients with Fuchs endothelial corneal dystrophy who underwent DSAEK in 1 eye and DMEK in the fellow eye. Patients were genotyped for the triplet repeat expansion in the TCF4 gene and imaged using optical coherence tomography, Scheimpflug imaging, and in vivo confocal microscopy through focusing. RESULTS Eight of 9 subjects were genotyped, and all were found to harbor the triplet repeat expansion. The average time between endothelial keratoplasty and imaging was 76 ± 22 and 37 ± 9 months after DSAEK and DMEK, respectively. The mean best spectacle-corrected visual acuity (logMAR) was 0.04 ± 0.05 and 0.11 ± 0.03 in the DMEK eyes versus DSAEK eyes (P = 0.02), respectively. Posterior corneal higher order aberrations were less in the DMEK eyes compared with fellow DSAEK eyes (0.25 ± 0.06 and 0.66 ± 0.25, respectively, P ≤ 0.01). Using confocal microscopy through focusing, we found that the persistent anterior stromal haze was correlated between the right and left eyes (R = 0.73, P ≤ 0.05), but total stromal backscattering was higher for the DSAEK eyes (P ≤ 0.05). CONCLUSIONS DSAEK inherently results in higher total stromal backscattering (haze) compared with DMEK because of the addition of stromal tissue. Lower higher order aberrations of the posterior cornea and lower total stromal backscattering (haze) may both contribute to superior visual outcomes after DMEK compared with DSAEK.
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Descemet Membrane Endothelial Keratoplasty in Asian Eyes: Intraoperative and Postoperative Complications. Cornea 2021; 39:940-945. [PMID: 32452991 DOI: 10.1097/ico.0000000000002302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe intraoperative and postoperative complications of Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes. METHODS A: prospective comparative study of consecutive cases of DMEK cases between January 2016 and January 2018. A subgroup of consecutive patients were optimized with preoperative topical eye drops and modification of donor insertion. Main outcome measures were intraoperative complications and total surgical time. Secondary outcome measures were postoperative complications and endothelial cell loss (ECL) at the 6-month follow-up. RESULTS We included 50 consecutive patients in this study; mean age of 66 ± 9 years old with 70% women. The indications for DMEK were Fuchs endothelial dystrophy (82%) and bullous keratopathy (18%). When compared with the standard group (n = 24 eyes), the optimized DMEK group (n = 26 eyes) was associated with a significantly reduced surgical time (33.9 ± 12.7 vs. 26.9 ± 7.6 minutes; P = 0.041), lower ECL at 6 months (27.2 ± 17.1% vs. 13.7 ± 9.7%; P = 0.012) and lower risk of high vitreous pressure causing iris prolapse (16.7% vs. 0%; P = 0.046). Multivariate analysis revealed a shorter surgical time (Odds Ratio [OR]: 0.924; 95% confidence interval: 0.858-0.995; P = 0.036) and reduced ECL (OR: 0.907; 95% confidence interval: 0.843-0.977; P = 0.01) in the optimized group. CONCLUSIONS We observed intraoperative challenges such as difficulty with donor insertion with increased vitreous pressure in Asian eyes by performing DMEK surgery, which may be reduced with anticipated preoperative and postoperative measures.
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Basak SK, Basak S, Gajendragadkar N, Ghatak M. Overall clinical outcomes of Descemet membrane endothelial keratoplasty in 600 consecutive eyes: A large retrospective case series. Indian J Ophthalmol 2021; 68:1044-1053. [PMID: 32461427 PMCID: PMC7508153 DOI: 10.4103/ijo.ijo_1563_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To analyze the overall clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in 600 consecutive cases. Methods: Retrospective, consecutive interventional case series operated by a single surgeon. Six hundred consecutive eyes of 524 patients with endothelial dysfunctions of different etiologies scheduled for DMEK were included in this study. All donor tissues were prepared by the operating surgeon during the procedure, using McCarey Kaufman medium or Cornisol-preserved cornea with endothelial cell density (ECD) of ≥2500 cells/mm2. Indications, postoperative best spectacle-corrected visual acuity (BSCVA), ECD, endothelial cell loss (ECL), and complications were analyzed postoperatively between 3 months and 2 years. Results: The commonest indication was post-cataract corneal edema/bullous keratopathy in 262 (43.7%) eyes followed by Fuchs′ endothelial corneal dystrophy 218 (36.3%). Vision affected comorbidities were present in 91 (15.2%) eyes. In phakic eyes with cataract (222; 37%), DMEK was combined with cataract surgery (Triple-DMEK). BSCVA of ≥20/25 was achieved in 41.0%, 46.4%, 49.2%, and 48.7% of eyes at 3, 6, 12, and 24 months, respectively and stabilized at 6 months (P = 0.54). Mean ECD decreased from 2884 ± 178 cells/mm2 (n = 600) before surgery to 2223 ± 321 (n = 597), 2099 ± 354 (n = 524), 1918 ± 373 (n = 374), and 1772 ± 439 cells/mm2 (n = 158) at 3, 6, 12, and 24 months respectively. The corresponding mean ECL was 22.9 ± 11.4%, 27.2 ± 12.4%, 33.5 ± 13.0%, and 38.6 ± 14.3%, respectively (P < 0.05 for all-time points). The commonest complication was DM detachment in 59 (9.8%) eyes of which 23 (3.8%) eyes required rebubbling. Three (0.5%) eyes had primary graft failure. Endothelial rejection occurred in 7 (1.2%) eyes until the last follow-up. Conclusion: DMEK is a safe and effective procedure in different types of endothelial diseases with encouraging surgical and clinical outcomes. Complications are less and ECL percentage up to 2 years is acceptable.
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Affiliation(s)
- Samar K Basak
- Cornea Department, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Soham Basak
- Cornea Department, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Nidhi Gajendragadkar
- Cornea Department, Disha Eye Hospitals, Kolkata, West Bengal; Cornea Clinic, Kashyap Memorial Eye Hospital, Ranchi, Jharkhand, India
| | - Mrinmoyee Ghatak
- Cornea Department, Disha Eye Hospitals, Kolkata, West Bengal, India
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Price MO, Feng MT, Price FW. Endothelial Keratoplasty Update 2020. Cornea 2021; 40:541-547. [PMID: 33252380 DOI: 10.1097/ico.0000000000002565] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
ABSTRACT Endothelial keratoplasty has revolutionized the treatment of corneal endothelial dysfunction and lowered the threshold for treatment by providing rapid visual rehabilitation and setting a high standard for safety and efficacy. Over time, endothelial keratoplasty techniques have evolved toward the use of thinner tissue to optimize visual outcomes; refinements have facilitated donor tissue preparation, handling, and attachment; and adaptations have expanded utilization in eyes with challenging ocular anatomy. Despite early concerns about graft longevity, emerging 10-year endothelial cell loss and graft survival data have been encouraging. A shortage of human donor corneas restricts utilization in many areas of the world and is driving a search for keratoplasty alternatives. Further work is needed to expand the donor supply, minimize impediments to adoption, optimize graft survival, and improve refractive predictability.
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Sabater-Cruz N, Figueras-Roca M, Padró-Pitarch L, Tort J, Casaroli-Marano RP. Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques. PLoS One 2021; 16:e0249946. [PMID: 33831081 PMCID: PMC8031423 DOI: 10.1371/journal.pone.0249946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period. Methods Annual reports from the Catalan Transplant Organization, Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed. Results A total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067). Conclusion Endothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent with the main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach.
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Affiliation(s)
- Noelia Sabater-Cruz
- Institut Clinic d’Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
- * E-mail:
| | - Marc Figueras-Roca
- Institut Clinic d’Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lydia Padró-Pitarch
- Catalan Transplant Organization (Organització Catalana de Trasplantaments—OCATT), Barcelona, Spain
| | - Jaume Tort
- Catalan Transplant Organization (Organització Catalana de Trasplantaments—OCATT), Barcelona, Spain
| | - Ricardo P. Casaroli-Marano
- Institut Clinic d’Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Department of Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Ong HS, Ang M, Mehta J. Evolution of therapies for the corneal endothelium: past, present and future approaches. Br J Ophthalmol 2021; 105:454-467. [PMID: 32709756 PMCID: PMC8005807 DOI: 10.1136/bjophthalmol-2020-316149] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Indexed: 12/13/2022]
Abstract
Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues - regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Marcus Ang
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Jodhbir Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
- School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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