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

Anterior segment reconstruction with artificial iris and Descemet membrane endothelial keratoplasty: a staged surgical approach

2021 ◽  
pp. bjophthalmol-2020-317906
Author(s):  
Marcus Ang ◽  
Donald Tan
Keyword(s):  
Surgical Approach ◽  
Central Corneal Thickness ◽  
Intraoperative Complications ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Artificial Iris ◽  
Corneal Decompensation

PurposeTo describe a surgical approach that involves anterior segment reconstruction with CustomFlex Artificial Iris (CAI; HumanOptics, Erlangen, Germany) followed by Descemet membrane endothelial keratoplasty (DMEK) in complex eyes with corneal decompensation.MethodsRestrospective case series of eyes that underwent anterior segment restoration involving (1) synechiolysis of peripheral anterior synechiae and excision of iris remnants, (2) securing a well-fixated posterior chamber intraocular lens and (3) suture-fixated or capsular bag placement of CAI. All eyes then underwent DMEK using a pull-through technique with the DMEK EndoGlide (Network Medical Products, Ripon, UK). Main outcomes were successful anterior segment restoration and corneal clarity with central corneal thickness (CCT).ResultsFive eyes of five patients (median age 61 years, range 27–69 years; 60% female) underwent anterior segment reconstruction with CAI implantation (4 suture-fixated), followed by successful DMEK surgery (median 2 months later, range 1–5 months). There were no major intraoperative complications or primary graft failure, with one peripheral graft detachment that underwent a successful re-bubble at 1 week. All eyes had stable CAI implants and DMEK grafts remained clear at last follow-up with reduction in mean central corneal thickness (preoperative: 658±86 µm vs postoperative: 470±33 µm, p=0.005).ConclusionThis pilot study highlights a feasible approach of initial anterior segment reconstruction with CAI implantation, prior to DMEK, in eyes with significant anterior segment abnormalities such as iris damage or extensive peripheral anterior synechiae and corneal decompensation.

Potential Causes of Incomplete Visual Rehabilitation at 6 Months Postoperative After Descemet Membrane Endothelial Keratoplasty

2013 ◽  
Vol 156 (4) ◽  
pp. 780-788.e1 ◽  
Author(s):  
Isabel Dapena ◽  
Ru-Yin Yeh ◽  
Lamis Baydoun ◽  
Javier Cabrerizo ◽  
Korine van Dijk ◽  
...  
Keyword(s):  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Visual Rehabilitation ◽  
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.

Delayed postoperative interface keratitis due to Enterococcus faecalis after Descemet membrane endothelial keratoplasty

2021 ◽  
Vol 14 (1) ◽  
pp. e238389
Author(s):  
Priyanka Sudana ◽  
Sunita Chaurasia ◽  
Joveeta Joseph ◽  
Dilip Kumar Mishra
Keyword(s):  
Enterococcus Faecalis ◽  
Visual Outcome ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Visual Rehabilitation ◽  
Descemet Membrane ◽  
Corrected Visual Acuity ◽  
Graft Removal ◽  
Microbiological Cure

To report the clinical course and management of interface keratitis due to Enterococcus faecalis after Descemet membrane endothelial keratoplasty (DMEK). A 64-year-old man underwent DMEK, with unevenful immediate postoperative course, with a visual recovery of 20/30 at 2 weeks. At 3 months of clinical visit, interface keratitis was noted. DMEK graft removal with stromal bed scrapings was performed. A diagnosis of E. faecalis interface keratitis was made. The patient responded favourably to antibiotic susceptibility-guided intensive treatment with vancomycin 5% with complete resolution of infection. After 2 months of graft removal, Descemet stripping endothelial keratoplasty (DSEK) was performed. The corneal clarity was restored and the best corrected visual acuity was 20/40 at last follow-up of 1 year. E. faecalis should be kept as a differential in delayed onset interface keratitis after DMEK. After microbiological cure with antibiotic therapy, visual rehabilitation with DSEK restores corneal clarity and results in favourable visual outcome.

Descemet-stripping Automated Endothelial Keratoplasty—A Review

2011 ◽  
Vol 04 (01) ◽  
pp. 80
Author(s):  
Anita M Hwang ◽  
Jimmy K Lee ◽  
◽  
Keyword(s):  
Penetrating Keratoplasty ◽  
Surgical Techniques ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Corneal Surface ◽  
Visual Rehabilitation ◽  
Descemet Membrane ◽  
Structural Recovery ◽  
Corneal Endothelial Dysfunction

Descemet-stripping automated endothelial keratoplasty (DSAEK) has become the procedure of choice to treat corneal endothelial dysfunction. The technique involves replacing the diseased host endothelium with a graft consisting of a thin layer of posterior stroma, Descemet membrane, and endothelium. In comparison to penetrating keratoplasty (PK), DSAEK confers quicker visual and structural recovery with absence of corneal surface incisions or sutures, and limits astigmatism. DSAEK has been proved to successfully achieve favorable visual acuity and graft clarity in bullous keratopathy, posterior polymorphous dystrophy, and failed PK grafts. This article discusses various DSAEK surgical techniques, short- and longterm post-surgical results, complications, and comparisons with other types of keratoplasty. With the advent of Descemet membrane endothelial keratoplasty (DMEK), in which only Descemet membrane is transplanted, visual rehabilitation may be attained sooner.

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.

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