Primary Descemet’s Membrane Endothelial Keratoplasty for Fuchs Endothelial Dystrophy versus Bullous Keratopathy: Histopathology and Clinical Results

AbstractThe aim of this study was to compare aqueous humour (AqH) cytokine profiles before and after Descemet’s membrane endothelial keratoplasty (DMEK) in eyes with bullous keratopathy (BK) and age-matched normal eyes. A total of 49 participants (mean age 75.0 ± 13.5 years) were divided into three groups: (1) BK patients scheduled for DMEK (BK group); (2) patients after DMEK (DMEK group; average postoperative time 1,018 ± 460 days); and (3) control participants without corneal endothelial disease scheduled for cataract surgery (control group). AqH (0.2 mL) was collected from all participants, and the levels of various AqH cytokines were simultaneously measured using a multiplex bead immunoassay. The DMEK group exhibited significantly lower concentrations of several pro-inflammatory cytokines, such as IL-1β, IL-5, IL-6, IL-10, and IL-8, and granulocyte colony stimulating factor than the BK group. In addition, the levels of IL-1β and IL-5 were significantly lower in the DMEK group than in the control group. The AqH levels of several pro-inflammatory cytokines were significantly reduced after DMEK, indicating that regeneration of the endothelial pump owing to the transplantation of a healthy endothelium might have a positive effect on anterior chamber inflammation.

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Descemet’s Membrane Endothelial Keratoplasty for Pseudoexfoliation Syndrome: A Case Series

10.21203/rs.2.229/v1 ◽

2019 ◽

Author(s):

Saho Tase ◽

Toshiki Shimizu ◽

Takahiko Hayashi ◽

Hitoshi Tabuchi ◽

Koji Niimi ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Corneal Thickness ◽

Reduction Rate ◽

Case Series ◽

Pseudoexfoliation Syndrome ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane

Abstract BacKground: To evaluate the clinical outcomes and features of Descemet’s membrane endothelial keratoplasty (DMEK) for eyes with pseudoexfoliation syndrome (PEX). Methods: In this retrospective study, 37 DMEK cases were reviewed from available medical records. Patients who exhibited endothelial dysfunction derived from PEX or Fuchs endothelial corneal dystrophy (FECD) and successfully underwent cataract surgery about four weeks before DMEK were enrolled. The best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and incidence of intra-operative/post-operative complications of DMEK were analyzed. Results: This study included 14 eyes of 14 patients (PEX: n=6, FECD: n=8). There was no primary graft failure. In the PEX group, BSCVA improved from 0.67 ± 0.28 at the preoperative point to 0.43 ± 0.14 at 1 month, 0.27 ± 0.10 at 3 months, and 0.19 ± 0.08 at 6 months after DMEK. The donor corneal ECD was 2,704 ± 225 cells/mm2 at the preoperative point and decreased to 1,691 ± 498 cells/mm2 at 1 month, 1,425 ± 366 cells/mm2 at 3 months, and 1,281 ± 340 cells/mm2 (52.7 ± 11.7% less than ECD of the donor graft) at 6 months after DMEK. None of the patients required rebubbling. When compared with the FECD group, no statistical difference was observed in CCT (p=0.821); BSCVA (p=0.001) and the reduction rate of ECD (p=0.010) were relatively worse. Conclusions: DMEK is effective for the treatment of endothelial dysfunction due to PEX. Keywords: Descemet’s membrane endothelial keratoplasty, pseudoexfoliation syndrome, bullous keratopathy, endothelial keratoplasty

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Predictive Factors for Clinical Outcomes after Primary Descemet’s Membrane Endothelial Keratoplasty for Fuchs’ Endothelial Dystrophy

Current Eye Research ◽

10.1080/02713683.2018.1538459 ◽

2018 ◽

Vol 44 (2) ◽

pp. 147-153 ◽

Cited By ~ 5

Author(s):

Tobias Brockmann ◽

Daniel Pilger ◽

Claudia Brockmann ◽

Anna-Karina B. Maier ◽

Eckart Bertelmann ◽

...

Keyword(s):

Clinical Outcomes ◽

Predictive Factors ◽

Endothelial Keratoplasty ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Fuchs Endothelial Dystrophy

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Descemet’s Stripping Automated Endothelial Keratoplasty versus Descemet’s Membrane Endothelial Keratoplasty in the Fellow Eye for Fuchs Endothelial Dystrophy: A Retrospective Study

BioMed Research International ◽

10.1155/2015/750567 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Vipul Bhandari ◽

Jagdeesh K. Reddy ◽

Kirti Relekar ◽

Vijayalakshmi Prabhu

Keyword(s):

Case Series ◽

Visual Outcome ◽

Endothelial Keratoplasty ◽

Fellow Eye ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Fuchs Endothelial Dystrophy ◽

Fellow Eyes

Aim. To evaluate visual outcome and endothelial cell density (ECD) after Descemet’s Membrane Endothelial Keratoplasty (DMEK) in comparison with Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in the fellow eye for Fuchs endothelial dystrophy (FED).Design. Single-centre, retrospective case series.Methods. 30 eyes of 30 patients undergoing DMEK, who completed a 1-year follow-up, were compared with 30 fellow eyes which underwent DSAEK for bilateral FED. Main outcome measures studied included Best Corrected Visual Acuity (BCVA) and ECD during a 1-year follow-up period.Results. BCVA improved from 0.78 ± 0.35 logMAR, and 0.73 ± 0.31 logMAR before surgery to 0.22 ± 0.1 logMAR and 0.35 ± 0.12 logMAR 6 months after DMEK and DSEK, respectively (P<0.001). At one year after surgery, the BCVA was maintained at 0.21 ± 0.12 logMAR and 0.34 ± 0.1 logMAR, respectively, after DMEK and DSAEK. A statistically better visual outcome was observed after DMEK compared to DSAEK (P<0.05) in fellow eyes.Conclusions. DMEK provided better visual rehabilitation when compared to DSAEK. Nevertheless, there were no significant differences with regard to the ECD within a 1-year follow-up.

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Corneal pachymetry by AS-OCT after Descemet’s membrane endothelial keratoplasty

Scientific Reports ◽

10.1038/s41598-021-93186-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Friso G. Heslinga ◽

Ruben T. Lucassen ◽

Myrthe A. van den Berg ◽

Luuk van der Hoek ◽

Josien P. W. Pluim ◽

...

Keyword(s):

Deep Learning ◽

Endothelial Function ◽

Corneal Thickness ◽

Anterior Segment ◽

Anatomical Landmarks ◽

Endothelial Keratoplasty ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Thickness Measurements

AbstractCorneal thickness (pachymetry) maps can be used to monitor restoration of corneal endothelial function, for example after Descemet’s membrane endothelial keratoplasty (DMEK). Automated delineation of the corneal interfaces in anterior segment optical coherence tomography (AS-OCT) can be challenging for corneas that are irregularly shaped due to pathology, or as a consequence of surgery, leading to incorrect thickness measurements. In this research, deep learning is used to automatically delineate the corneal interfaces and measure corneal thickness with high accuracy in post-DMEK AS-OCT B-scans. Three different deep learning strategies were developed based on 960 B-scans from 50 patients. On an independent test set of 320 B-scans, corneal thickness could be measured with an error of 13.98 to 15.50 μm for the central 9 mm range, which is less than 3% of the average corneal thickness. The accurate thickness measurements were used to construct detailed pachymetry maps. Moreover, follow-up scans could be registered based on anatomical landmarks to obtain differential pachymetry maps. These maps may enable a more comprehensive understanding of the restoration of the endothelial function after DMEK, where thickness often varies throughout different regions of the cornea, and subsequently contribute to a standardized postoperative regime.

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