Does Preoperative or Postoperative Graft Thickness Influence Postoperative Visual Acuity in Descemet Stripping Automated Endothelial Keratoplasty for Advanced Pseudophakic Bullous Keratopathy?

Cornea ◽  
2019 ◽  
Vol 38 (11) ◽  
pp. 1358-1363
Author(s):  
Jean-Marc Perone ◽  
Pauline Rolland Le Moal ◽  
Maxime Sot ◽  
Florian Bloch ◽  
Alireza Maleki ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Postoperative Visual Acuity ◽  
Pseudophakic Bullous Keratopathy ◽  
Graft Thickness

scholarly journals Results of posterior lamellar femto-keratoplasty using two different lasers

2020 ◽  
pp. 36-42
Author(s):  
B.E. Malyugin ◽  
◽  
A.N. Pashtaev ◽  
N.F. Shilova ◽  
K.N. Kuzmichev ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Optical Density ◽  
Bullous Keratopathy ◽  
Interface Zone ◽  
Postoperative Astigmatism ◽  
C:P Ratio ◽  
Pseudophakic Bullous Keratopathy ◽  
Graft Thickness ◽  
Observation Period

Purpose. To evaluate the results of treatment of patients with pseudophakic bullous keratopathy (PBK) by the method of posterior lamellar femto-keratoplasty with ultrathin graft (FS-DSEK) harvested using two different lasers. Material and methods. The results of surgical treatment of 82 patients (82 eyes) underwent posterior lamellar femto-keratoplasty for PBK were analyzed. In the 1st group included 43 patients (43 eyes) with PBK underwent FS-DSEK using FS laser Femto-Visum (Optosystems, Russia). In the 2nd group included 39 patients (39 eyes) with PBK underwent FS-DSEK using LDV Z8 (Ziemer, Switzerland). Observation period was 1 year. Before and after surgery following indicators were evaluated: uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), postoperative astigmatism, central corneal thickness (CCT), graft thickness, center-periphery (C:P) ratio, endothelial cell density (ECD), endothelial cell (EC) loss, optical density. Results. Transparent engraftment at 1-year observation period was observed in 88% of cases. In the 1st group UCVA=0.22±0.11, BSCVA=0.32±0.12, in the 2nd group UCVA=0.18±0.08, BSCVA=0.29±0.1 (p>0.05). The maximum BSCVA in both groups was 0.6. Postoperative astigmatism was comparative in 2nd groups – 1.43±1.1 and 1.38±1.0 D, respectively (p>0.05). In the 1st group, CCT=549±31, graft thickness in the central zone – 83±12, C:P ratio – 0.92±0.05; in the 2nd group CCT=546±28, graft thickness – 80±10, C:P ratio – 0.94±0.06 (p>0.05). In the 1st group ECD – 1326±282, EC loss – 55±6%; ECD in the 2nd – 850±230, EC loss – 70±7% (p<0.05). According to the results of densitometry, optical density of the posterior layers of the cornea and «donor–recipient» interface zone was higher in the 2nd group, both in the central and in the paracentral zones: in the 1st group in the posterior layers of the stroma – 16.4±1.2 (0–2 mm) and 15.8±1.0 (2–6 mm), in the interface zone – 14.5±0.9 (0–2) and 13.9±0.8 (2–6), in the 2nd group in the posterior layers – 18.3±1.3 (0–2 mm) and 17.9±1.1 (2–6 mm), and in the interface zone – 17.3±1.2 (0–2 mm) and 17.0±1.0 (2–6 mm, p<0.05). Conclusions. FS-DSEK showed high efficiency for treating patients with PBK. Functional results were comparative in 2nd groups. Statistical analysis showed highest safety of transplanted endothelium in the 1st group at 1-year observation period. Key words: pseudophakic bullous keratopathy, femtosecond laser, posterior lamellar keratoplasty, corneal endotheliumultrathin graft.

scholarly journals Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

2020 ◽  
Vol 5 (1) ◽  
pp. e000546
Author(s):  
Vito Romano ◽  
Luca Pagano ◽  
Kunal A Gadhvi ◽  
Giulia Coco ◽  
Mitchell Titley ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Corneal Dystrophy ◽  
University Hospital ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Corrected Visual Acuity ◽  
Pseudophakic Bullous Keratopathy ◽  
Best Corrected Visual Acuity

ObjectiveTo compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK).Methods and analysisComparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures.Results56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01.ConclusionPl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.

Effect of preoperative duration of stromal edema in bullous keratopathy on early visual acuity after endothelial keratoplasty

2012 ◽  
Vol 38 (2) ◽  
pp. 303-308 ◽  
Author(s):  
Naoyuki Morishige ◽  
Tai-ichiro Chikama ◽  
Naoyuki Yamada ◽  
Norihisa Takahashi ◽  
Yukiko Morita ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Stromal Edema

scholarly journals Outcomes of Resident-Performed Descemet's Stripping Automated Endothelial Keratoplasty

2017 ◽  
Vol 09 (01) ◽  
pp. e26-e31
Author(s):  
Tatyana Beketova ◽  
Margaret Pfeiffer ◽  
Alice Chuang ◽  
Gene Kim
Keyword(s):  
Graft Failure ◽  
Glaucoma Patient ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Ocular Surgery ◽  
Pseudophakic Bullous Keratopathy ◽  
Primary Graft Failure

Purpose This article aimed to evaluate outcomes of resident-performed Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods This is a case series of patients who underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery. Results Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline. Conclusion With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes.

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