Influence of Early Descemet Stripping Endothelial Keratoplasty on Visual Outcomes in Pseudophakic Corneal Edema

Purpose. To examine the impact of graft thickness (GT) on postoperative visual acuity and endothelial cell density after ultrathin-Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus conventional DSAEK. Methods. The medical records of all patients who underwent DSAEK at our institute during a 2-year period were reviewed. After excluding subjects with low visual potential, 34 eyes were divided into two groups based on the postoperative GT as measured with anterior segment optical coherence tomography (AS-OCT): an UT-DSAEK group (GT ≤ 100 μm, n=13 eyes) and a DSAEK group (GT > 100 μm, n=21 eyes). The groups were compared with regard to best-corrected visual acuity (BCVA), subjective refraction, central corneal thickness (CCT), GT, and endothelial cell density (ECD). Results. Preoperative BCVA (logMAR) was 1.035 ± 0.514 and 0.772 ± 0.428 for UT-DSAEK and DSAEK, respectively (P=0.072). At 6 months postoperatively, BCVA was 0.088 ± 0.150 following UT-DSAEK and 0.285 ± 0.158 following DSAEK (P=0.001). Conclusion. DSAEK grafts with a thickness under 100 μm offered better visual outcomes during the early postoperative period.

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Erratum to “Visual Outcomes of Ultrathin-Descemet Stripping Endothelial Keratoplasty versus Descemet Stripping Endothelial Keratoplasty”

Journal of Ophthalmology ◽

10.1155/2019/4786431 ◽

2019 ◽

Vol 2019 ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

Konstantinos Droutsas ◽

Myrsini Petrelli ◽

Dimitrios Miltsakakis ◽

Konstantinos Andreanos ◽

Anastasia Karagianni ◽

...

Keyword(s):

Endothelial Keratoplasty ◽

Descemet Stripping Endothelial Keratoplasty ◽

Visual Outcomes

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Outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) Using Surgeon’s Prepared Donor DM-Roll in Consecutive 100 Indian Eyes

The Open Ophthalmology Journal ◽

10.2174/1874364101812010134 ◽

2018 ◽

Vol 12 (1) ◽

pp. 134-142 ◽

Cited By ~ 5

Author(s):

Samar K Basak ◽

Soham Basak ◽

Viraj R Pradhan

Keyword(s):

Endothelial Cell ◽

Corneal Edema ◽

Cell Loss ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Endothelial Cell Loss ◽

Corneal Surgery ◽

Descemet Membrane ◽

Visual Outcomes

Background:Descemet Membrane Endothelial Keratoplasty (DMEK) is now becoming the popular form of endothelial keratoplasty using only donor DM with healthy endothelium as true component lamellar corneal surgery.Objective:To analyze the results of visual outcomes, endothelial cell loss and complications of Descemet membrane endothelial keratoplasty in first consecutive 100 Indian eyes.Methods:100 eyes of 95 consecutive patients with endothelial dysfunctions of different etiologies scheduled for DMEK, were included in this study. In each case, surgeon prepared tissue using McCarey Kaufman medium- or Cornisol-preserved donor cornea with a cell count of ≥2500 cells/mm2. Surgical complications, Best Spectacle Corrected Visual Acuity (BSCVA); Endothelial Cell Density (ECD) and Endothelial Cell Loss (ECL) were analyzed for each patient after a minimum follow-up of three months.Results:The Main indication was pseudophakic corneal edema or bullous keratopathy in 52 (52%) eyes. 38 (38%) eyes had Fuchs′ dystrophy with various grades of cataract. In 43 phakic eyes, DMEK was combined with cataract surgery and intraocular lens implantation. Mean DM-roll preparation time was 7.5 ± 2.8 min and in 3 eyes, DM-graft were damaged. After 3-months, BSCVA was ≥20/25 in 57 (57.6%) cases. Mean ECD was 2123 ± 438/mm2(range: 976 - 3208/ mm2) and the mean endothelial cell loss after 3-months was 26.92 ± 13.40 (range: 4.90 - 66.6%). Partial DM detachment occurred in 8 (8.0%) eyes and rebubbling required in 4 eyes. Iatrogenic primary graft failure occurred in one eye.Conclusion:Descemet membrane endothelial keratoplasty is a safe and effective procedure in several types of endothelial diseases among Indian patients with encouraging surgical and visual outcomes. Complications are less and endothelial cell loss percentage is acceptable.

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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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Descemet-stripping endothelial keratoplasty and flange technique of scleral fixation of intraocular lens: Making it easier and safer

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2017.08.005 ◽

2017 ◽

Vol 43 (9) ◽

pp. 1238-1239 ◽

Cited By ~ 1

Author(s):

Seema Ramakrishnan ◽

Pratyusha Ganne ◽

Nagesha C. Krishnappa ◽

Prabu Baskaran

Keyword(s):

Intraocular Lens ◽

Endothelial Keratoplasty ◽

Scleral Fixation ◽

Descemet Stripping Endothelial Keratoplasty

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Experimental rationale for using a viscoprotection of the corneal endothelium on the graft formed with a femtosecond laser for the descemet stripping endothelial keratoplasty

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-94-96 ◽

2021 ◽

pp. 94-96

Author(s):

I.S. Tkachenko ◽

◽

B.E. Malyugin ◽

S.A. Borzenok ◽

D.S. Ostrovskiy ◽

...

Keyword(s):

Endothelial Cells ◽

Femtosecond Laser ◽

Corneal Endothelium ◽

Hydroxypropyl Methylcellulose ◽

Lamellar Keratoplasty ◽

Confocal Laser ◽

Control Group ◽

Endothelial Keratoplasty ◽

Descemet Stripping Endothelial Keratoplasty ◽

Experimental Group

Purpose. To rationale experimentally the use of a viscoprotection of the corneal endothelium on the graft formed with a femtosecond laser for the descemet stripping endothelial keratoplasty. Material and methods. In our study, we used 12 pig's corneoscleral discs. The preservation time before the experiment averaged 12±4 hours. The corneas were divided into 2 groups. In the operating room, the graft was formed using an LDV Z8 femtosecond laser (Ziemer, Switzerland) from the endothelial side. Before applanation of the donor cornea and femtolaser head, a 1% solution of hydroxypropyl methylcellulose (HPMC) was applied to the endothelium - experimental group. The control group was appraised according to the standard technique, with the application of a few drops of a solution for storing the corneas. Then the applanation was monitored and evaluated by laser optical coherence tomography. Then the graft was separated from the bed and transferred to a conservation medium. Under laboratory conditions, to determine the viability of endothelial cells, the graft was stained with a «vital» dye with the commercial name Life and Dead (Abcam, UK) and placed in a confocal laser scanning microscope. Endothelial cells were counted using the ImageJ software. Results. In the experimental and control groups, the number of living endothelial cells (EC) was 91.06±1.49% and 83.86±2.14%, respectively (p<0.001). The number of dead ECs in the control group was 7.2±0.65% more than in the experimental group and amounted to 16.14±2.14% and 8.94±1.49%, respectively (p<0.001). Conclusion. The study demonstrated that the use of viscoprotection of the corneal graft endothelium for posterior lamellar keratoplasty is quite effective, and significantly reduces the loss of EC at the stage of cutting out the graft with a femtosecond laser. Key words: descemet stripping endothelial keratoplasty, femtosecond laser, vital dyes.

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