scholarly journals Visual Outcomes of Ultrathin-Descemet Stripping Endothelial Keratoplasty versus Descemet Stripping Endothelial Keratoplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Konstantinos Droutsas ◽  
Myrsini Petrelli ◽  
Dimitrios Miltsakakis ◽  
Konstantinos Andreanos ◽  
Anastasia Karagianni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Endothelial Cell Density ◽  
Endothelial Keratoplasty ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Visual Outcomes ◽  
The Impact

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.

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.

scholarly journals Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas

2020 ◽  
Vol 40 (12) ◽  
pp. 3403-3412
Author(s):  
Carlo Cagini ◽  
F. Riccitelli ◽  
M. Messina ◽  
F. Piccinelli ◽  
G. Torroni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Corneal Thickness ◽  
Endothelial Cell Density ◽  
Cross Linking ◽  
Corneal Transplant ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Abstract Purpose To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients. Methods In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400 µm, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100 µm thick and of 8.5 mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Results CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379–414 µm, mean 387.6 µm. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91 ± 1.9 and 50.75 ± 2.93, respectively, and at 12 months mean K1 was 47.36 ± 2.66 and mean K2 50.53 ± 3.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283 µm and 267 µm, respectively) and in some cases at 6 months. Reduced keratocyte density and stromal oedema were observed immediately up to 1 month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6 months. Conclusion This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.

scholarly journals A New User-Friendly and Affordable Method in Descemet Stripping Endothelial Keratoplasty

2018 ◽  
Vol 12 (1) ◽  
pp. 242-246
Author(s):  
Mohammad Soleimani ◽  
Seyed Ali Tabatabaei ◽  
Reza Mirshahi
Keyword(s):  
Endothelial Cell ◽  
Cell Density ◽  
Endothelial Cell Density ◽  
New Technique ◽  
Endothelial Keratoplasty ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
A New Technique ◽  
User Friendly

Aims: To describe a new technique in Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Materials and Methods: In this technique, we use easily available materials (mainly a Nelaton tube) to make an injector for loading DSAEK lenticule and also easily pulling it (using a gauge 23 needle) into the eye. In this paper, we report outcomes of this technique in four cases. Results: Using these available instruments could easily lead to a clear postoperative cornea. Mean Endothelial Cell Density (ECD) loss at sixth postoperative month was 26%. Conclusion: We proposed a novel effective user-friendly and affordable technique to perform DSAEK.

scholarly journals Effect of the retention ring-assisted continuous application of riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus

2019 ◽  
Author(s):  
Chung Young Kim ◽  
Mee Kum Kim
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Corneal Thickness ◽  
Endothelial Cell Density ◽  
Cross Linking ◽  
Pulsed Light ◽  
Continuous Application ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Abstract Background: To investigate the efficacy and safety of the retention ring-assisted continuous application of 0.1% riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus. Methods: The medical records of 20 eyes of 18 patients with progressive keratoconus who received collagen cross-linking at Seoul National University Hospital were retrospectively reviewed. Isotonic 0.1% riboflavin was continuously applied for 10 minutes using an 8.0-mm retention ring before the irradiation and accelerated cross-linking was applied with 30-mW pulsed-ultraviolet light at a wavelength 365 nm for eight minutes (1 second on/1 second off; 30 mW/cm2, cumulative dose of 7.2J/cm2) without further intermittent application of riboflavin. Visual acuity, refractive error, topographic index, corneal thickness, and endothelial cell density were evaluated before the operation and at 1, 3, 6, and 12 months. Results: The best corrected visual acuity in logMAR improved from preoperative 0.43 to 0.17 in 12 months (p = 0.050). Maximum keratometry decreased from 51.8 D to 50.4 D at six months (p = 0.015) and 50.1 D at 12 months (p = 0.0003). Astigmatism decreased from preoperative 5.5 D to 4.1 D at 12 months (p < 0.0001). Thinnest corneal thickness decreased at three and six months but recovered in 12 months (p > 0.05). Endothelial cell density decreased at postoperative one month (p = 0.02) but gradually recovered in 12 months (p > 0.05). Conclusions: Retention ring-assisted continuous application of riboflavin for ten minutes in pulsed-light accelerated cross-linking is a comparably safe and effective treatment for halting the progression of keratoconus in 12 months when compared to outcomes of the standard Dresden protocol shown in previous reports.

scholarly journals Comparison of endothelial/Descemet’s membrane complex thickness with endothelial cell density for the diagnosis of corneal transplant rejection

2018 ◽  
Vol 10 ◽  
pp. 251584141881418 ◽  
Author(s):  
Christopher Smith ◽  
Daniel Kaitis ◽  
Jordan Winegar ◽  
Sean Edelstein ◽  
Matthew Council ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Cell Density ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Endothelial Cell Density ◽  
High Definition ◽  
Membrane Complex ◽  
Descemet's Membrane ◽  
Descemet’S Membrane

Purpose: This study compared the effectiveness of endothelial/Descemet’s membrane complex thickness obtained using high-definition anterior segment optical coherence tomography with endothelial cell density obtained using confocal microscopy as diagnostic tools in predicting corneal transplant rejection. Methods: This observational, prospective, cross-sectional study evaluated penetrating keratoplasty grafts. Slit lamp examination organized the grafts into healthy or rejecting grafts. Grafts were scanned using both high-definition anterior segment optical coherence tomography and confocal microscopy. Central corneal thickness, endothelial/Descemet’s membrane complex thickness, endothelial cell density, and coefficient of variation were each compared with the clinical status. Descemet’s rejection index, defined by endothelial/Descemet’s membrane complex thickness divided by central corneal thickness multiplied by 33, further compared endothelial/Descemet’s membrane complex thickness with central corneal thickness. Results: Endothelial/Descemet’s membrane complex thickness, central corneal thickness, and Descemet’s rejection index were all able to differentiate between clear and rejected corneal grafts ( p < 0.0001, p = 0.001, and p = 0.012, respectively). Endothelial cell density and coefficient of variation did not correlate with the clinical status ( p = 0.054 and p = 0.102, respectively). Endothelial/Descemet’s membrane complex thickness had the largest area under the curve using receiver operating characteristic curves ( p < 0.0001). Endothelial/Descemet’s membrane complex thickness had a sensitivity of 86% and specificity of 81% with a cutoff value of >16.0 µm ( p < 0.0001). The sensitivity and specificity of endothelial cell density were both 71% with a cutoff value of ⩽897 cells/mm2 ( p = 0.053). There was a high correlation between endothelial/Descemet’s membrane complex thickness and both Descemet’s rejection index and central corneal thickness ( p < 0.0001). Conclusion: Endothelial/Descemet’s membrane complex thickness measured by high-definition anterior segment optical coherence tomography is a useful parameter for the diagnosis of corneal graft rejection. The diagnostic performance of endothelial/Descemet’s membrane complex thickness was significantly better than that of endothelial cell density and central corneal thickness. Endothelial cell density and the coefficient of variation were unable to diagnose corneal graft rejection in our cross-sectional study.

scholarly journals Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

2020 ◽  
Vol 259 (1) ◽  
pp. 113-119
Author(s):  
Doreen Koechel ◽  
Nicola Hofmann ◽  
Jan D. Unterlauft ◽  
Peter Wiedemann ◽  
Christian Girbardt
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Failure Rate ◽  
Graft Failure ◽  
Endothelial Cell Density ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Median Change

Abstract Purpose This study aims to investigate possible differences in clinical outcomes between precut and surgeon-cut grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods 142 consecutive patients who underwent DMEK were included in the study. 44 patients received precut tissues, and 98 patients received surgeon-cut tissues. Precut grafts were allocated to the patient by the German Society for Tissue Transplantation if available. We compared the outcomes of both groups for changes in visual acuity, central corneal thickness, endothelial cell density, re-bubbling rate, and graft failure rate. Results Patients who received precut tissues experienced similar increase in visual acuity (median change 0.4 logMAR) and decrease of corneal swelling (median change 132 μm) compared with those who received surgeon-cut tissues (median VA change 0.3 logMAR, p = 0.55, CCT change 118 μm, p = 0.63). There was no statistical difference in endothelial cell density (1436 vs. 1569 cells/mm2, p = 0.37), re-bubbling (32% vs. 35%, p = 0.85), and graft failure rate (5% vs. 1%, p = 0.23). No primary graft failure occurred in the group of precut grafts. Conclusion Both methods lead to comparable results for visual acuity, corneal deswelling, endothelial cell density, and re-bubbling rate. A previously described higher graft failure rate for precut tissues could not be confirmed in our study. Thus, we do not see medical reasons against the use of precut tissues. There are several advantages of precut DMEK tissues over surgeon-cut tissues, especially the prevention of graft loss during preparation in the operating theater.

scholarly journals Outcomes after Descemet membrane endothelial keratoplasty over a period of 7 years at a tertiary referral center: endothelial cell density, central corneal thickness, and visual acuity

2021 ◽  
Author(s):  
Tarek Bayyoud ◽  
Faik Gelisken ◽  
Jens Martin Rohrbach ◽  
Gunnar Blumenstock ◽  
Karl Ulrich Bartz-Schmidt ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Group 2 ◽  
Group 1

Abstract Purpose To better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)). Methods Consecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density. Results Postoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p <.001; 1.15 to .87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1. Conclusion Eyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.

scholarly journals Effect of the Retention Ring-Assisted Continuous Application of Riboflavin in Pulsed-Light Accelerated Corneal Collagen Cross-Linking on the Progression of Keratoconus

2018 ◽  
Author(s):  
Chung Young Kim ◽  
MD Mee Kum Kim
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Corneal Thickness ◽  
Endothelial Cell Density ◽  
Cross Linking ◽  
Pulsed Light ◽  
Continuous Application ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Abstract Purpose: To investigate the efficacy and safety of the retention ring-assisted continuous application of 0.1% riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus. Methods: The medical records of 20 eyes of 18 patients with progressive keratoconus who received collagen cross-linking at Seoul National University Hospital were retrospectively reviewed. Isotonic 0.1% riboflavin was continuously applied for 10 minutes using an 8.0-mm retention ring before the irradiation and accelerated cross-linking was applied with 30-mW pulsed-ultraviolet light at a wavelength 365 nm for eight minutes (1 second on/1 second off; 30 mW/cm2, cumulative dose of 7.2J/cm2) without further intermittent application of riboflavin. Visual acuity, refractive error, topographic index, corneal thickness, and endothelial cell density were evaluated before the operation and at 1, 3, 6, and 12 months. Results: The best corrected visual acuity in logMAR improved from preoperative 0.43 to 0.18 in 12 months. Maximum keratometry decreased from 51.8 D to 50.4 D at six months (p = 0.015) and 50.3 D at 12 months (p < 0.0001). Astigmatism decreased from preoperative 5.5 D to 4.2 D at 12 months (p < 0.0001). Thinnest corneal thickness decreased at three and six months but recovered in 12 months (p > 0.05). Endothelial cell density decreased at one month (p = 0.02) but gradually recovered in 12 months (p > 0.05). Conclusions: Continuous application of riboflavin using a retention ring for 10 minutes in an accelerated pulsed-light collagen cross-linking seems to be safe and effective for halting the progression of the keratoconus.

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