Descemet membrane endothelial keratoplasty in vitrectomized eyes: a case series of outcomes and complications

2021 ◽  
Author(s):  
Maria Phylactou ◽  
Francesco Matarazzo ◽  
Nizar Din ◽  
Vincenzo Maurino
Keyword(s):  
Case Series ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes with failure of primary Descemet membrane endothelial keratoplasty (DMEK)

2018 ◽  
Vol 103 (5) ◽  
pp. 599-603 ◽  
Author(s):  
Shmuel Graffi ◽  
Pia Leon ◽  
Yoav Nahum ◽  
Shay Gutfreund ◽  
Rossella Spena ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Tertiary Care ◽  
Case Series ◽  
Care Hospital ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Visual Rehabilitation ◽  
Descemet Membrane ◽  
Graft Thickness ◽  
Iol Exchange

AimTo evaluate the outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes after failure of primary Descemet membrane endothelial keratoplasty (DMEK).MethodsThis was a retrospective, non-comparative interventional case series done in a tertiary care hospital. The study group included 21 eyes of patients which underwent UT-DSAEK following the failure of primary DMEK. Outcome measures included best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD) both recorded 6 and 12 months postoperatively as well as central graft thickness (CGT) measured 6 months after UT-DSAEK.ResultsWhen considering only eyes without comorbidities (17 of 21), 12 months after UT-DSAEK, BSCVA was ≥20/25 in 12/13 (92%) eyes and ≥20/20 in 4/13 (30%) eyes. Mean ECD loss rate was 38.9% at 12 months postoperatively (range 8%–57%). Six months postoperatively, CGT averaged at 81±34 µm (range 34–131 µm). No intraoperative complications were recorded. Postoperatively, one patient (no. 8) had graft wrinkles that were fixed 2 days following UT-DSAEK. Four patients have developed intraocular lens (IOL) opacification, and two of them underwent IOL exchange. No other postoperative complications were recorded.ConclusionsUT-DSAEK is instrumental in the management of primary DMEK graft failure, allowing visual rehabilitation which is comparable with that of repeat DMEK.

Case Series of Urrets-Zavalia Syndrome After Descemet Membrane Endothelial Keratoplasty

Cornea ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Paramjit K. Bhullar ◽  
Nandini Venkateswaran ◽  
Terry Kim
Keyword(s):  
Case Series ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Scrolling of the Donor Cornea in Dependence of Temperature and Osmolarity for Descemet Membrane Endothelial Keratoplasty

2020 ◽  
Author(s):  
Markus Gruber ◽  
Thomas Reinhard ◽  
Katrin Wacker ◽  
Philip Christian Maier
Keyword(s):  
Case Series ◽  
Culture Conditions ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Future Studies ◽  
Descemet Membrane ◽  
Reflected Light ◽  
Median Diameter ◽  
Different Temperatures ◽  
Donor Corneas

Abstract Background After preparation of a graft for Descemet membrane endothelial keratoplasty (DMEK), the diameter of the graftʼs scroll varies significantly. In particular, narrow scrolls may complicate DMEK surgery. In this study we investigated how temperature, osmolarity, and deswelling of the donor tissue influence scrolling diameter. Material and Methods In this study we examined donor corneas that could not be used for transplantation. The diameter of the DMEK donor scrolls was measured after graft preparation by reflected light microscopy under different conditions: (1) The diameter of the roll was measured in Ringerʼs solution at temperatures of 5 °C, 24 °C and 35 °C. (2) To study the effect of different culture conditions we used 6% dextran-containing medium for 10 min, 20 min, 16 h and 24 h, and hyper- and hypoosmolar fluids (5% NaCl or aqua dest) for 5 min each. Results The median donors age was 62 years. The median endothelial cell density of the donor corneas was 1679 cells/mm2. The median diameter of the DMEK scroll was 1.35 mm in Ringerʼs solution at 24 °C (IQR, 1.04 – 1.89). In Ringerʼs solution at different temperatures, the scrolling diameter changed between 0.02 mm and 0.29 mm. The change in osmolarity resulted in a difference of 0.02 mm to 0.46 mm. Deswelling with dextran resulted in a change of scrolling diameter between 0.02 mm and 0.09 mm. Summary In this experimental case series, the diameter of the DMEK scroll did not change due to changes of temperature, osmolarity or deswelling. Influencing the graftʼs scroll to standardize and simplify the DMEK surgery remains an interesting goal for future studies.

Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) for Fuchs endothelial corneal dystrophy: 6 months clinical outcome

2018 ◽  
Vol 102 (10) ◽  
pp. 1425-1430 ◽  
Author(s):  
Vasiliki Zygoura ◽  
Lamis Baydoun ◽  
Lisanne Ham ◽  
Vincent J A Bourgonje ◽  
Korine van Dijk ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Clinical Outcome ◽  
Case Series ◽  
Corneal Dystrophy ◽  
Endothelial Cell Migration ◽  
Hybrid Technique ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Tertiary Referral Centre ◽  
Descemet Membrane

Background/aimTo assess the clinical outcome of the first series of Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK), a potential hybrid technique between ‘descemetorhexis only’ and conventional, circular DMEK.MethodsProspective interventional case series at a tertiary referral centre. Twelve eyes of 12 patients with central Fuchs endothelial corneal dystrophy underwent Quarter-DMEK, that is, transplantation of one quadrant of a full-diameter DMEK graft, and were evaluated for best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications up to 6 months postoperatively.ResultsAt 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5), 11/12 (92%) of ≥20/25 (≥0.8) and 6/12 (50%) of ≥20/20 (≥1.0). Mean central ECD decreased from 2867 (±161) cells/mm2 before to 1255 (±514) cells/mm2 at 1 month, 1058 (±455) cells/mm2 at 3 months and 968 (±427) cells/mm2 at 6 months after surgery. Rebubbling was performed in 4/12 eyes (33%) within the first two months.ConclusionsQuarter-DMEK may be a feasible procedure that allows for visual outcomes similar to conventional, circular DMEK. The relatively large drop in ECD within the first month may have resulted from more extensive endothelial cell migration and/or measurement error (at the graft edges). If longer-term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.

scholarly journals Management of upside-down descemet membrane endothelial keratoplasty: A case series

2020 ◽  
Vol 32 (2) ◽  
pp. 142
Author(s):  
AhmedShalaby Bardan ◽  
MohamedB Goweida ◽  
HeshamF El Goweini ◽  
ChristopherS C Liu
Keyword(s):  
Case Series ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Hybrid Descemet Membrane Endothelial Keratoplasty (H-DMEK): results of a donor insertion pull-through technique using donor stroma as carrier

2020 ◽  
Vol 104 (10) ◽  
pp. 1358-1362 ◽  
Author(s):  
Jyh Haur Woo ◽  
Hla Myint Htoon ◽  
Donald Tan
Keyword(s):  
Endothelial Cell ◽  
Case Series ◽  
Cell Loss ◽  
Corneal Dystrophy ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Descemet Membrane ◽  
Pull Through

AimTo evaluate the outcomes and complications of hybrid Descemet membrane endothelial keratoplasty (H-DMEK) using a Descemet stripping automated endothelial keratoplasty (DSAEK) pull-through donor inserter and donor stroma as carrier.MethodsThis was a retrospective interventional case series of eyes with bullous keratopathy (BK) and Fuchs endothelial corneal dystrophy (FECD), which underwent H-DMEK, performed using a bimanual pull-through technique using DSAEK-prepared donor stroma as carrier and the EndoGlide Ultrathin DSAEK donor insertion device. Complex cases with tube shunts, trabeculectomy, aphakia, aniridia, previous vitrectomy, keratoplasty or combined with intraocular lens exchange, were also included. The outcome measures were intraoperative and postoperative complications, best corrected visual acuity (BCVA) and endothelial cell loss after surgery.ResultsOf the 85 eyes from 79 patients, 43.5% (n=37) had BK, 28.2% (n=24) had FECD while 24.7% (n=21) had failed grafts. DMEK was performed in 37 complex eyes (43.5%). Four eyes (4.7%) required rebubbling for graft detachment and two cases of graft failure were observed. A BCVA of 20/25 or better was attained in 44.7% and 57.1% of eyes without pre-existing ocular pathology at 6 and 12 months, respectively. The overall endothelial cell loss was 32.2%±20.5% at 6 months, which improved from 37.2%±20.9% to 24.2%±17.5%, comparing the first 40 and last 45 cases (p=0.012).ConclusionHybrid DMEK offers a controlled ‘pull-through’ technique of donor insertion in the ‘endothelium-in’ configuration, which may be useful especially in complicated eyes. More studies are needed to confirm the long-term endothelial cell loss and graft survival associated with this technique.

scholarly journals Visual Quality and Subjective Satisfaction in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK): A Fellow-Eye Comparison

2021 ◽  
Vol 10 (3) ◽  
pp. 419
Author(s):  
Josep Torras-Sanvicens ◽  
Irene Blanco-Domínguez ◽  
José-María Sánchez-González ◽  
Rahul Rachwani-Anil ◽  
Juan-Felipe Spencer ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Quality Assessment ◽  
Cell Density ◽  
Case Series ◽  
Visual Quality ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Background: To analyze objective and subjective visual quality differences between descemet membrane endothelial keratoplasty (DMEK) and ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a paired contralateral-eye design. Methods: A cross-sectional, comparative, and observational case series study between DMEK and UT-DSAEK were presented. Visual acuity, refractive status and corneal quality assessment were compared between both endothelial keratoplasty techniques. The sample consisted of 20 eyes (10 patients) diagnosed with Fuchs endothelial corneal dystrophy. All measurements were performed preoperatively and at six months after surgery. Analyzed data included the measurement of objective scattering index, modulation transfer function, Strehl ratio, and optical quality assessment (OQAS) values. Contrast sensitivity, subjective patient satisfaction, visual acuity, tomography, pachymetry, endothelial cell count, and refraction status were also analyzed. Results: Objective and subjective visual quality variables had similar results among UT-DSAEK and DMEK procedures. Statistically significant differences favoring DMEK against UT-DSAEK were found in endothelial cell density (658.80 ± 139.33 and 1059.00 ± 421.84 cells/mm2, respectively), pachymetry (621.20 ± 33.74 and 529.70 ± 30.00 µm, respectively), and follow-up (45.50 ± 24.76 and 15.50 ± 8.43 months, respectively). Conclusions: UT-DSAEK and DMEK revealed no differences in terms of objective and subjective visual quality. However, DMEK showed a faster recovery during the follow-up, increased endothelial cell density, lower pachymetry, and a more anatomical posterior keratometry against UT-DSAEK in this case series paired-eye study.

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