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.

scholarly journals Evaluation of Donor and Recipient Characteristics Involved in Descemet Stripping Automated Endothelial Keratoplasty Outcomes

2021 ◽  
Vol 8 ◽  
Author(s):  
Michele Lanza ◽  
Rosa Boccia ◽  
Adriano Ruggiero ◽  
Paolo Melillo ◽  
Mario Bifani Sconocchia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Eye Bank ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Aims: To evaluate both donor and recipient features involved in visual acuity restoring and complication insurgence in eyes that have undergone Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: In this retrospective study, charts of 111 eyes of 96 patients (mean age 70.25 ± 8.58 years) that underwent DSAEK were evaluated. Only Fuch's Distrophy (FD) or Bullous Keratopathy (BK) due to cataract surgery eyes were included. A complete ophthalmic check with endothelial cell density (ECD) and central corneal thickness (CCT) measurement was performed before surgery and at 1, 3, 6, and 12 months follow-up. Each DSAEK was performed by the same well-trained surgeon; only pre-cut lenticules, provided by same Eye Bank, were implanted.Results: A total of 48 (43%) complications have been observed (most of them were 22 partial graft detachments and 17 IOP spikes). At the last follow-up (mean: 8.58 ± 4.09 months), a significant increase (p &lt; 0.05) of best corrected visual acuity (BCVA) was detected. Overall mean BCVA of the eyes evaluated was 0.40 ± 0.43 LogMAR with BK eyes showing a significantly higher improvement (p &lt; 0.05) compared to FD eyes. The only factor showing a significant correlation (p &lt; 0.05) with visual acuity enhancement was the implant of a lenticule thinner than 100 μm. Recipient features significantly (p &lt; 0.05) associated with complications observed after surgery were glaucoma and diabetes mellitus.Conclusion: The use of a graft thinner than 100 μm can provide better visual acuity recovery while recipients affected by glaucoma or diabetes mellitus are more prone to develop complications after surgery.

scholarly journals Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Zahra Ashena ◽  
Thomas Hickman-Casey ◽  
Mayank A. Nanavaty
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

scholarly journals Surgical Outcomes of Phacoemulsification Surgery in a Restructured Asian Training Hospital

1970 ◽  
Vol 12 (4) ◽  
pp. 201-207
Author(s):  
David Zhiwei Law ◽  
Seng Chee Loon ◽  
Wan Ling Wong ◽  
Marilou Sevilla Ebreo ◽  
Xiang Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Outcomes ◽  
Perioperative Complications ◽  
University Hospital ◽  
Complication Rates ◽  
Corrected Visual Acuity ◽  
Duration Of Surgery ◽  
National University ◽  
Chi Squared ◽  
Best Corrected Visual Acuity

Aim: To evaluate the surgical outcomes of phacoemulsification performed at National University Hospital, Singapore, with emphasis on the results achieved by residents.Methods: This was a retrospective analysis of surgical outcomes of patients who underwent phacoemulsification in a restructured hospital in 2008. The study included 318 eyes of patients of predominantly Asian descent. Pre- and postoperative best-corrected visual acuity, perioperative complications and associations of patient, surgical and surgeon factors were studied. One-way analysis of variance for means, chi-squared test for proportions, and multivariate analyses were performed to determine factors associated with postoperative best-corrected visual acuity outcomes. Main outcome measures included postoperative best-corrected visual acuity, degree of improvement in best-corrected visual acuity, and achievement of specific best-corrected visual acuity targets of 6/9 and 6/12 at postoperative months 1 and 3.Results: Duration of surgery of less than 20 minutes was found to be significantly associated with better postoperative best-corrected visual acuity. Level of surgical experience was also associated with betterpostoperative best-corrected visual acuity at postoperative months 1 (p < 0.001) and 3 (p = 0.004). While senior consultants produced the best postoperative best-corrected visual acuity outcomes, the results achieved by residents were comparable to those reported in prior resident-only studies. For surgeries performed by residents, the overall rate of posterior capsule rupture was 3.1% with a 0.0% rate of vitreous loss.Conclusions: The continued close guidance and training of ophthalmology residents in a restructured Asian training hospital will ensure that complication rates remain low while maintaining postoperative outcomes at safe levels.

scholarly journals The effect of amblyopia on clinical outcomes of children with astigmatism

2021 ◽  
Vol 13 ◽  
pp. 251584142110408
Author(s):  
Burçin Çakır ◽  
Nilgün Özkan Aksoy ◽  
Sedat Özmen ◽  
Özlem Bursalı
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Medical Records ◽  
Convergence Insufficiency ◽  
Corrected Visual Acuity ◽  
Ocular Deviation ◽  
The Mean ◽  
The Difference ◽  
Best Corrected Visual Acuity

Background: Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. Objective: To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. Methods: We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. Results: The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. Conclusion: A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.

scholarly journals Association of foveal avascular zone with the metamorphopsia in epiretinal membrane

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hideki Shiihara ◽  
Hiroto Terasaki ◽  
Shozo Sonoda ◽  
Naoko Kakiuchi ◽  
Hidetaka Yamaji ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Superficial Layer ◽  
University Hospital ◽  
Foveal Avascular Zone ◽  
Service Unit ◽  
Corrected Visual Acuity ◽  
Avascular Zone ◽  
The Mean ◽  
The Relationship ◽  
Best Corrected Visual Acuity

Abstract This study was to investigate the relationship between the metamorphopsia and foveal avascular zone (FAZ) parameter in eyes with epiratinal membrane (ERM). We studied patients with an ERM visited retinal service unit at the Kagoshima University Hospital or Shirai Hospital. The best-corrected visual acuity (BCVA), and the degree of metamorphopsia by M -CHARTS™ were evaluated. The 3 × 3 mm optical coherence tomography angiography (OCTA) images of the superficial layer were obtained. Area (mm2), the circularity, eigen value were calculated using ImageJ software. The relationship between visual function, such as best corrected visual acuity (BCVA) and metamorphopsia, and FAZ parameters were studied by Pearson’s correlational coefficient. Fifty-four eyes of 51 patients (24 men and 27 women) with an ERM were studied. The mean age of the patients was 69.6 ± 8.20 years. The mean BCVA and metamorphopsia score was 0.31 ± 0.29 logMAR units and 0.49 ± 0.42. There was no significant relationship between BCVA and FAZ parameters. While, metamorphopsia score was significantly and negatively correlated with all of FAZ parameters (area R = − 0.491, P < 0.001; circularity R = − 0.385, P = 0.004; eigenvalue ratio R = − 0.341; P = 0.012). Multiple regression analysis showed the FAZ area was solely and significantly correlated with metamorphopsia score (β − 0.479, P < 0.001). The size but not the shape of the FAZ was significantly correlated with the degree of metamorphopsia suggesting that it could be an objective parameter of metamorphopsia in ERM patients.

scholarly journals Spontaneous Corneal Clearance in the Presence of a Partially Detached Graft after Non-Descemet Stripping Automated Endothelial Keratoplasty

2016 ◽  
Vol 7 (2) ◽  
pp. 320-326 ◽  
Author(s):  
Konstantinos Droutsas ◽  
Apostolos Lazaridis ◽  
Chrysanthi Koutsandrea ◽  
Klio I. Chatzistefanou ◽  
Marilita M. Moschos ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Visual Acuity ◽  
Bullous Keratopathy ◽  
Spontaneous Clearance ◽  
Endothelial Keratoplasty ◽  
Invasive Treatment ◽  
Corrected Visual Acuity ◽  
Simplex Virus ◽  
The Right

Purpose: To report the explantation of a detached and opaque donor disc as an alternative to secondary keratoplasty in a case of persistent graft detachment followed by spontaneous clearance of the recipient cornea after non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). Methods: A 57-year-old man with cataract and bullous keratopathy after herpes simplex virus endotheliitis of the right eye and best spectacle-corrected visual acuity (BSCVA) of 0.1 underwent simultaneous phacoemulsification and non-DSAEK. Due to early detachment of the donor disc, two additional intracameral air injections were necessary in order to achieve graft attachment. However, the donor disc gradually detached and became fibrotic while the recipient cornea anterior to the detached graft became transparent and without any edema. Therefore, a mere explantation of the DSAEK graft was performed. Results: Four months after graft explantation, BSCVA was 0.5 and endothelial cell density (ECD) was 1,221 cells/mm2. After 13 months, BSCVA was still 0.6 while ECD had fell to 800, and 2 years later, the endothelium decompensated. BSCVA was 0.3 and ECD was not measurable. Conclusions: To our knowledge this is the first report of explantation of an endothelial graft as an alternative to re-keratoplasty in a case of spontaneous corneal clearance. This minimally invasive treatment may be considered in similar cases. However, due to the ongoing loss of endothelial cells after endothelial keratoplasty, a re-keratoplasty may still be needed in the long term.

scholarly journals DMEK IN KERATOCONUS WITH ACUTE HYDROPS: A CASE REPORT

2018 ◽  
Vol 17 (3) ◽  
pp. 81
Author(s):  
Lucio V L Maranhão ◽  
Paulo E C Dantas ◽  
Natalia R L Ramalho ◽  
Wanessa P Pinto
Keyword(s):  
Visual Acuity ◽  
Corneal Edema ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Hand Motion ◽  
Severe Visual Loss ◽  
Corrected Visual Acuity ◽  
Corneal Hydrops ◽  
The Right ◽  
Initial Results ◽  
Best Corrected Visual Acuity

We describe the initial results of a Descemet Membrane Endothelial Keratoplasty (DMEK) procedure for acute corneal hydrops in a 45-years female with keratoconus that presented with severe visual loss in the left eye (OS). The patients’ best-corrected visual acuity at presentation in the right eye was 20/80 and hand motion in OS. Slit-lamp examination revealed an extensive Descemet’s membrane tear and stromal corneal edema in OS. Two months after the DMEK procedure, the patient presented with a best corrected visual acuity of 20/200 in the affected eye, corneal edema improvement, and an attached Descemet graft.  

scholarly journals Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8–10 years follow-up

2022 ◽  
Author(s):  
Julia M. Weller ◽  
Friedrich E. Kruse ◽  
Theofilos Tourtas
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Clinical Outcomes ◽  
Cell Density ◽  
Corneal Thickness ◽  
Endothelial Cell Density ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Abstract Purpose This study aimed to evaluate the clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK). Methods In this retrospective, consecutive, single-center case series the medical files of eyes which have received DMEK between 2009 and 2012 for the treatment of endothelial dysfunction was evaluated regarding follow-up time and clinical outcomes. Annual examinations of best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT) of 66 eyes which fulfilled the criterion of a minimum of 8 years follow-up were analyzed. Results BCVA improved from 0.55 ± 0.37 logMAR (n = 54) to 0.15 ± 0.11 (n = 47) in eyes without ocular comorbidities one year after DMEK (p < 0.001), and remained stable up to 10 years after DMEK. Mean ECD decreased to 744 ± 207 cells/mm2 (n = 39) after 9 years, and to 729 ± 167 cells/mm2 (n = 21) after 10 years, respectively. CCT decreased from 650 ± 67 μm before DMEK to 525 ± 40 μm (n = 56) after 1 year, increasing slowly to 563 ± 40 µm (n = 39) after 9 years, and to 570 ± 42 µm (n = 21) after 10 years, respectively. Graft failure occurred in 4 of 66 eyes after year 8. These 4 eyes required repeat DMEK after 101–127 months. Conclusion This study shows the long-term outcomes in a small subset of DMEK grafts. Visual acuity remained stable in spite of slowly increasing corneal thickness and diminishing endothelial cell density during the 10-year period after DMEK.

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