Effect of Cornea Donor Graft Thickness on the Outcome of Descemet Stripping Automated Endothelial Keratoplasty Surgery

Descemet membrane endothelial keratoplasty (DMEK) is a corneal surgical technique which selectively replaces the damaged posterior part of the cornea with a healthy donor graft retaining the rest of the tissue intact. There is a need to validate and standardize the donor tissue before grafting due to certain issues that can lead to consequences such as graft failure due to poor endothelial cell count, higher mortality, detachment of the graft, or increased surgical expenses, time, and effort. Thus, prospective potential surgeons and eye banks should now aim at developing new improved surgical techniques in order to prepare the best suited, validated, precut, preloaded, and easy to transplant tissue to reduce pre- and postsurgical complications. This could be achieved by defining parameters like graft thickness, accepted mortality threshold of the endothelial cells, and behavior of grafts during preservation and transportation along with using more sophisticated instruments like microkeratome and femtosecond lasers for graft preparation. Thus, a rapport between the eye banks and the surgeons along with the advanced instruments can overcome this challenge to find the best possible solution for endothelial keratoplasty (EK).

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Graft detachments in endothelial keratoplasty

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318092 ◽

2021 ◽

pp. bjophthalmol-2020-318092

Author(s):

Rashmi Deshmukh ◽

Sridevi Nair ◽

Darren Shu Jeng Ting ◽

Tushar Agarwal ◽

Jacqueline Beltz ◽

...

Keyword(s):

Risk Factors ◽

Preventive Measures ◽

Endothelial Keratoplasty ◽

Common Complication ◽

Prevention Measures ◽

Descemet Stripping Endothelial Keratoplasty ◽

Secondary Interventions ◽

Different Types ◽

Incidence Risk ◽

Donor Graft

Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet’s membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.

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Intraoperative optical coherence tomography guided corneal sweeping for removal of remnant Interface fluid during ultra-thin Descemet stripping automated endothelial keratoplasty

BMC Ophthalmology ◽

10.1186/s12886-021-01934-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Mimouni ◽

Martin Kronschläger ◽

Manuel Ruiss ◽

Oliver Findl

Keyword(s):

Optical Coherence Tomography ◽

Retrospective Study ◽

Optical Coherence ◽

Endothelial Keratoplasty ◽

Intraoperative Optical Coherence Tomography ◽

Graft Thickness

Abstract Background Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK. Methods This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not. Results Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 μm to 3.46 ± 9.52 μm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01). Conclusion The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.

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Dislocation of the Donor Graft to the Posterior Segment in Descemet Stripping Automated Endothelial Keratoplasty

American Journal of Ophthalmology ◽

10.1016/j.ajo.2011.09.006 ◽

2012 ◽

Vol 153 (4) ◽

pp. 638-642.e2 ◽

Cited By ~ 19

Author(s):

Natalie A. Afshari ◽

Mark S. Gorovoy ◽

Sonia H. Yoo ◽

Terry Kim ◽

Alan N. Carlson ◽

...

Keyword(s):

Posterior Segment ◽

Endothelial Keratoplasty ◽

Donor Graft

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

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311834 ◽

2018 ◽

Vol 103 (5) ◽

pp. 599-603 ◽

Cited By ~ 2

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.

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