Long-term outcomes of Descemet stripping automated endothelial keratoplasty for bullous keratopathy after argon laser iridotomy

2021 ◽  
Author(s):  
Yunyan Ye ◽  
Natsuko Mori ◽  
Akira Kobayashi ◽  
Hideaki Yokogawa ◽  
Kazuhisa Sugiyama
Keyword(s):  
Argon Laser ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Long Term Outcomes ◽  
Laser Iridotomy

scholarly journals Clinical Evaluation of the NS Endo-Inserter, a Novel Donor Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

2019 ◽  
Vol 10 (3) ◽  
pp. 357-364
Author(s):  
Akira Kobayashi ◽  
Hideaki Yokogawa ◽  
Natsuko Mori ◽  
Tsubasa Nishino ◽  
Kazuhisa Sugiyama
Keyword(s):  
Anterior Chamber ◽  
Clinical Outcomes ◽  
Intraoperative Complications ◽  
Case Series ◽  
Argon Laser ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Donor Tissue ◽  
Laser Iridotomy ◽  
Cell Densities

Purpose: This study investigated the clinical outcomes achieved with a newly developed donor inserter (NS Endo-Inserter [NSI], HOYA Co., Ltd., Tokyo, Japan) for Descemet’s stripping automated endothelial keratoplasty (DSAEK) in Japanese eyes with bullous keratopathy secondary to argon laser iridotomy (BK-ALI). The NSI device utilizes pressure flow to push the DSAEK donor tissue into the anterior chamber. Methods: Six eyes of 6 patients (1 male, 5 females; mean age, 78.5 years) with BK-ALI were enrolled. Donor tissue was pushed into the anterior chamber using the NSI. Intraoperative complications, graft dislocation, and iatrogenic primary graft failure were recorded for all eyes. Six-month postoperative central donor endothelial cell densities (ECD) were measured prospectively and compared with preoperative values, along with 6-month best corrected visual acuity (BCVA). Results: In all cases, donor loading onto the NSI spatula and donor insertion into the anterior chamber using the NSI was smooth and successful; no intraoperative complications were noted. There were no cases of graft dislocation or IPGF. Postoperative ECD was 2,187.2 cells/mm2 (mean loss, 14.8%) and mean BCVA increased from 0.27 decimal to 0.8 at 6 months. Conclusion: In this small preliminary case series, clinical outcomes for patients with BK-ALI undergoing DSAEK using the NSI were comparable or better than those achieved with conventional DSAEK insertion techniques.

scholarly journals Wheel Spokes Technique for Endothelial Keratoplasty for Extremely Mydriatic Bullous Keratopathy Eyes without Capsular Support

2018 ◽  
Vol 9 (1) ◽  
pp. 238-242 ◽  
Author(s):  
Hidenori Tanaka ◽  
Koji Hirano ◽  
Masayuki Horiguchi
Keyword(s):  
Cataract Surgery ◽  
Argon Laser ◽  
Vitreous Cavity ◽  
Bullous Keratopathy ◽  
Sphincter Muscle ◽  
Endothelial Keratoplasty ◽  
Laser Iridotomy ◽  
Acute Glaucoma ◽  
A New Technique ◽  
Capsular Support

We describe a new technique to prevent an endothelial donor graft from dropping into the vitreous cavity during non-Descemet stripping automated endothelial keratoplasty (nDSAEK) for extremely mydriatic bullous keratopathy (BK) eyes without capsular support. The patient was a 79-year-old woman who underwent nDSAEK for an extremely mydriatic BK eye with an incomplete barrier between the anterior and posterior chambers. She had undergone argon laser iridotomy for acute glaucoma at the age of 59 years and cataract surgery 3 years later. The pupil was extremely mydriatic as a result of iris sphincter muscle damage associated with an acute glaucoma attack and cataract surgery. After cataract surgery, the dislocated intraocular lens (IOL) sometimes touched the corneal endothelium. Despite simultaneous surgery to remove the dislocated IOL and lens capsule, vitrectomy, and intrascleral IOL fixation, her corneal endothelial decompensation progressed to BK. During nDSAEK, three 9-0 Prolene suture threads were placed through the recipient’s cornea, limbus-to-limbus, resembling wheel spokes, to prevent the graft from dropping into the vitreous cavity. With the aid of these pre-placed sutures, the graft was inserted safely and was well attached to the host’s posterior cornea by air tamponade without suturing. The wheel spokes technique prevented the endothelial graft from dropping during intraoperative manipulation, suggesting that nDSAEK is possible even in an extremely mydriatic aphakic BK eye without capsule support.

scholarly journals Long-term outcomes of endothelial keratoplasty in Chinese eyes at a University Hospital

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Alvin L Young ◽  
Rachel PW Kwok ◽  
Vishal Jhanji ◽  
Lulu L Cheng ◽  
Srinivas K Rao
Keyword(s):  
University Hospital ◽  
Endothelial Keratoplasty ◽  
Long Term Outcomes

Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty in Postvitrectomized Eyes With the Use of Pars Plana Infusion

Cornea ◽  
2020 ◽  
Vol 39 (4) ◽  
pp. 457-460 ◽  
Author(s):  
Zale Mednick ◽  
Nir Sorkin ◽  
Adi Einan-Lifshitz ◽  
Gisella Santaella ◽  
Tanya Trinh ◽  
...  
Keyword(s):  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Long Term Outcomes ◽  
Descemet Membrane ◽  
Pars Plana

Endothelial keratoplasty with anterior chamber intraocular lens versus secondary posterior chamber intraocular lens

2020 ◽  
pp. bjophthalmol-2020-316711
Author(s):  
Jyh Haur Woo ◽  
Anshu Arundhati ◽  
Soon-Phaik Chee ◽  
Weihan Tong ◽  
Lim Li ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Graft Survival ◽  
Intraocular Lens ◽  
Posterior Chamber ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Significant Difference ◽  
Iris Claw ◽  
Iol Exchange

AimTo describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL.MethodsThis was a retrospective comparative cohort study. The clinical data of 82 eyes from 82 consecutive patients with pseudophakic (PBK) or aphakic bullous keratopathy (ABK) who either underwent DSAEK with retained or secondary ACIOL (n=23) or DSAEK with IOL exchange and/or secondary PCIOL (retropupillary iris-claw IOL, n=25; intrascleral-fixated IOL, n=29; or sulcus IOL, n=5) were analysed. The main outcome measures were graft survival and complications up to 5 years.ResultsThe graft survival in the secondary PCIOL group was superior than the ACIOL group over 5 years (year 1, 100.0% vs 100.0%; year 3, 94.7% vs 75.0%; year 5, 91.1% vs 60.6%, p=0.022). The presence of an ACIOL was a significant risk factor associated with graft failure (HR, 4.801; 95% CI, 1.406 to 16.396, p=0.012) compared to a secondary PCIOL. There was no significant difference in the rate of graft detachment and elevated intraocular pressure between the groups. There were five cases (9.3%) of IOL subluxation or dislocation in the retropupillary iris-claw and intrascleral-fixated IOL groups.ConclusionsEyes that underwent DSAEK with ACIOL in situ had poorer long-term graft survival compared with those with secondary PCIOL. Intraocular lens exchange was not associated with a higher complication rate. In ABK or PBK eyes with ACIOL, we recommend performing IOL exchange and/or secondary PCIOL implantation combined with endothelial keratoplasty.

scholarly journals Spontaneous Corneal Clearance in the Presence of a Partially Detached Graft after Non-Descemet Stripping Automated Endothelial Keratoplasty

2016 ◽  
Vol 7 (2) ◽  
pp. 320-326 ◽  
Author(s):  
Konstantinos Droutsas ◽  
Apostolos Lazaridis ◽  
Chrysanthi Koutsandrea ◽  
Klio I. Chatzistefanou ◽  
Marilita M. Moschos ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Visual Acuity ◽  
Bullous Keratopathy ◽  
Spontaneous Clearance ◽  
Endothelial Keratoplasty ◽  
Invasive Treatment ◽  
Corrected Visual Acuity ◽  
Simplex Virus ◽  
The Right

Purpose: To report the explantation of a detached and opaque donor disc as an alternative to secondary keratoplasty in a case of persistent graft detachment followed by spontaneous clearance of the recipient cornea after non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). Methods: A 57-year-old man with cataract and bullous keratopathy after herpes simplex virus endotheliitis of the right eye and best spectacle-corrected visual acuity (BSCVA) of 0.1 underwent simultaneous phacoemulsification and non-DSAEK. Due to early detachment of the donor disc, two additional intracameral air injections were necessary in order to achieve graft attachment. However, the donor disc gradually detached and became fibrotic while the recipient cornea anterior to the detached graft became transparent and without any edema. Therefore, a mere explantation of the DSAEK graft was performed. Results: Four months after graft explantation, BSCVA was 0.5 and endothelial cell density (ECD) was 1,221 cells/mm2. After 13 months, BSCVA was still 0.6 while ECD had fell to 800, and 2 years later, the endothelium decompensated. BSCVA was 0.3 and ECD was not measurable. Conclusions: To our knowledge this is the first report of explantation of an endothelial graft as an alternative to re-keratoplasty in a case of spontaneous corneal clearance. This minimally invasive treatment may be considered in similar cases. However, due to the ongoing loss of endothelial cells after endothelial keratoplasty, a re-keratoplasty may still be needed in the long term.

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