scholarly journals Development of a Donor Tissue Holding Technique for Descemet’s Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator

2018 ◽  
Vol 9 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Akira Kobayashi ◽  
Hideaki Yokogawa ◽  
Natsuko Mori ◽  
Toshinori Masaki ◽  
Kazuhisa Sugiyama
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Postoperative Complications ◽  
Endothelial Keratoplasty ◽  
Donor Tissue ◽  
Corrected Visual Acuity ◽  
Descemet’S Membrane Endothelial Keratoplasty ◽  
Descemet's Membrane ◽  
Descemet’S Membrane ◽  
Reproducible Manner

Purpose: To report a modified surgical technique called the “donor tissue holding technique for Descemet’s membrane endothelial keratoplasty (DMEK)” using a newly developed 25-gauge graft manipulator. Methods: Six consecutive patients exhibiting endothelial dysfunction were enrolled and treated by DMEK. In brief, after insertion of a DMEK donor into the anterior chamber, the edge of the roll was grasped using a graft manipulator and this grasp was maintained throughout the centering and opening of the roll (holding technique). The following parameters were evaluated in comparison to the previous 10 consecutive DMEK cases in which the no touch technique was used: time of graft unfolding, incidence of intra-/postoperative complications, and best spectacle-corrected visual acuity (BCVA) and endothelial cell density (ECD) 6 months after the procedure. Results: In both technique groups, neither intra- nor postoperative complications were noted in any case. No differences were observed between the two groups in postoperative BCVA (p = 0.88). Also, no differences were observed between the two groups in postoperative ECD (holding technique group: 2,108.3 cells/mm2, no touch technique group: 1,491.7 cells/mm2) (p = 0.08) Most notably, the time of graft unfolding prior to filling with air was significantly reduced in the holding technique group (305.5 s) compared to that of the no touch technique group (1,310.0 s; p = 0.01). Conclusions: This donor tissue holding technique enabled rapid and safe DMEK in a reproducible manner, even in Asian eyes with shallow anterior chambers with high vitreous pressure.

scholarly journals Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Takahiko Hayashi ◽  
Kentaro Yuda ◽  
Itaru Oyakawa ◽  
Naoko Kato
Keyword(s):  
Corneal Thickness ◽  
Vitreoretinal Surgery ◽  
Vital Staining ◽  
Brilliant Blue ◽  
Endothelial Keratoplasty ◽  
Brilliant Blue G ◽  
Corrected Visual Acuity ◽  
Descemet’S Membrane Endothelial Keratoplasty ◽  
Descemet's Membrane ◽  
Descemet’S Membrane

Vital staining of the endothelial graft is essential during Descemet’s membrane endothelial keratoplasty (DMEK) to ensure surgical success. DMEK surgeons worldwide commonly use trypan blue (TB) to this end. However, TB may exert toxic effects on both the cornea and retina. Recently, Brilliant Blue G (BBG) has become recognized as an alternative stain for use during vitreoretinal surgery; BBG is associated with lower levels of toxicity. We retrospectively analyzed the utility of BBG staining during DMEK. We used 0.1% (w/v) BBG to stain the DMEK grafts of 12 patients. We evaluated the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) before and 3 and 6 months after surgery. BBG was effective in terms of graft visualization during DMEK. The BSCVA (log  MAR) improved from0.99±0.57to0.01±0.07(p<0.05). The CCT decreased from720.3±58.1 μm preoperatively to511.5±50.6 μm at 6 months postoperatively (p=0.0001). The ECD decreased from2,754±296 cells/mm2to1,708±426 cells/mm2at 6 months postoperatively (p<0.001). The ECD loss was37.9±16.3%. The outcomes using BBG were comparable to those of earlier reports that employed TB; thus, BBG may be a viable alternative to TB.

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

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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