Can we predict the refractive outcome after triple Descemet membrane endothelial keratoplasty?

2018 ◽  
Vol 29 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Victor A Augustin ◽  
Julia M Weller ◽  
Friedrich E Kruse ◽  
Theofilos Tourtas
Keyword(s):  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Case Series ◽  
Corneal Curvature ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Refractive Outcome ◽  
Descemet Membrane ◽  
Corneal Volume ◽  
Posterior Corneal Curvature

Purpose: To analyze and correlate corneal parameters with refractive shift after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple Descemet membrane endothelial keratoplasty). Methods: This single-center retrospective observational case series included 152 eyes of 152 consecutive patients undergoing triple Descemet membrane endothelial keratoplasty in the first eye for Fuchs endothelial corneal dystrophy. Patients were examined preoperatively, as well as at 3, 6, and 12 months after surgery. The main outcome measures were: refractive shift (predicted refractive outcome based on intraocular lens calculation compared to actual postoperative refractive outcome), central corneal thickness, corneal volume, anterior and posterior corneal curvature, and corneal densitometry. These parameters were analyzed and correlated with the refractive shift after surgery. Results: After 3 months from surgery, a mean refractive shift of +1.12 ± 1.10 D was observed and remained stable until the last follow-up at 12 months (+1.24 ± 1.07 D). Correlation analysis showed a weak but significant positive correlation between refractive shift and preoperative posterior curvature (rho = 0.314; p = 0.002) or preoperative posterior densitometry (rho = 0.227; p = 0.008). No correlation was found between refractive shift and preoperative central corneal thickness, corneal volume, anterior curvature, or anterior/mid-cornea densitometry. Conclusion: Changes of the posterior cornea may have an influence on the refractive shift. Patients with flatter posterior corneal curvature or higher posterior corneal density seem to exhibit a higher hyperopic shift. The weak correlations indicate a poor predictive value of any preoperative parameter used in our study.

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.

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 Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy

2021 ◽  
Author(s):  
Bishr Agha ◽  
Nura Ahmad ◽  
Daniel G. Dawson ◽  
Thomas Kohnen ◽  
Ingo Schmack
Keyword(s):  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Corneal Astigmatism ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Corneal Densitometry ◽  
Scheimpflug Imaging ◽  
Fuchs Endothelial Dystrophy ◽  
Posterior Corneal Astigmatism

Abstract Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

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.

scholarly journals Predictors affecting myopic regression in − 6.0D to − 10.0D myopia after laser-assisted subepithelial keratomileusis and laser in situ keratomileusis flap creation with femtosecond laser-assisted or mechanical microkeratome-assisted

2019 ◽  
Vol 40 (1) ◽  
pp. 213-225 ◽  
Author(s):  
Jihong Zhou ◽  
Wei Gu ◽  
Shaowei Li ◽  
Lijuan Wu ◽  
Yan Gao ◽  
...  
Keyword(s):  
Femtosecond Laser ◽  
Contact Lens ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Case Series ◽  
Older Age ◽  
Laser In Situ Keratomileusis ◽  
Corneal Curvature ◽  
Case Series Study

Abstract Purpose To investigate the predictive factors of postoperative myopic regression among subjects who have undergone laser-assisted subepithelial keratomileusis (LASEK), laser-assisted in situ keratomileusis (LASIK) flap created with a mechanical microkeratome (MM), and LASIK flap created with a femtosecond laser (FS). All recruited patients had a manifest spherical equivalence (SE) from − 6.0D to − 10.0D myopia. Methods This retrospective, observational case series study analyzed outcomes of refraction at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Predictors affecting myopic regression and other covariates were estimated with the Cox proportional hazards model for the three types of surgeries. Results The study enrolled 496 eyes in the LASEK group, 1054 eyes in the FS-LASIK group, and 910 eyes in the MM-LASIK group. At 12 months, from − 6.0D to − 10.0D myopia showed that the survival rates (no myopic regression) were 52.19%, 59.12%, and 58.79% in the MM-LASIK, FS-LASIK, and LASEK groups, respectively. Risk factors for myopic regression included thicker postoperative central corneal thickness (P ≦ 0.01), older age (P ≦ 0.01), aspherical ablation (P = 0.02), and larger transitional zone (TZ) (P = 0.03). Steeper corneal curvature (Kmax) (P = 0.01), thicker preoperative central corneal thickness (P < 0.01), smaller preoperative myopia (P < 0.01), longer duration of myopia (P = 0.02), with contact lens (P < 0.01), and larger optical zone (OZ) (P = 0.02) were protective factors. Among the three groups, the MM-LASIK had the highest risk of postoperative myopic regression (P < 0.01). Conclusions The MM-LASIK group experienced the highest myopic regression, followed by the FS-LASIK and LASEK groups. Older age, aspheric ablation used, thicker postoperative central corneal thickness, and enlarging TZ contribute to myopic regression; steeper preoperative corneal curvature (Kmax), longer duration of myopia, with contact lens, thicker preoperative central corneal thickness, lower manifest refraction SE, and enlarging OZ prevent postoperative myopic regression in myopia from − 6.0D to − 10.0D.

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

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.

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