scholarly journals Outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) Using Surgeon’s Prepared Donor DM-Roll in Consecutive 100 Indian Eyes

2018 ◽  
Vol 12 (1) ◽  
pp. 134-142 ◽  
Author(s):  
Samar K Basak ◽  
Soham Basak ◽  
Viraj R Pradhan
Keyword(s):  
Endothelial Cell ◽  
Corneal Edema ◽  
Cell Loss ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Corneal Surgery ◽  
Descemet Membrane ◽  
Visual Outcomes

Background:Descemet Membrane Endothelial Keratoplasty (DMEK) is now becoming the popular form of endothelial keratoplasty using only donor DM with healthy endothelium as true component lamellar corneal surgery.Objective:To analyze the results of visual outcomes, endothelial cell loss and complications of Descemet membrane endothelial keratoplasty in first consecutive 100 Indian eyes.Methods:100 eyes of 95 consecutive patients with endothelial dysfunctions of different etiologies scheduled for DMEK, were included in this study. In each case, surgeon prepared tissue using McCarey Kaufman medium- or Cornisol-preserved donor cornea with a cell count of ≥2500 cells/mm2. Surgical complications, Best Spectacle Corrected Visual Acuity (BSCVA); Endothelial Cell Density (ECD) and Endothelial Cell Loss (ECL) were analyzed for each patient after a minimum follow-up of three months.Results:The Main indication was pseudophakic corneal edema or bullous keratopathy in 52 (52%) eyes. 38 (38%) eyes had Fuchs′ dystrophy with various grades of cataract. In 43 phakic eyes, DMEK was combined with cataract surgery and intraocular lens implantation. Mean DM-roll preparation time was 7.5 ± 2.8 min and in 3 eyes, DM-graft were damaged. After 3-months, BSCVA was ≥20/25 in 57 (57.6%) cases. Mean ECD was 2123 ± 438/mm2(range: 976 - 3208/ mm2) and the mean endothelial cell loss after 3-months was 26.92 ± 13.40 (range: 4.90 - 66.6%). Partial DM detachment occurred in 8 (8.0%) eyes and rebubbling required in 4 eyes. Iatrogenic primary graft failure occurred in one eye.Conclusion:Descemet membrane endothelial keratoplasty is a safe and effective procedure in several types of endothelial diseases among Indian patients with encouraging surgical and visual outcomes. Complications are less and endothelial cell loss percentage is acceptable.

Hybrid Descemet Membrane Endothelial Keratoplasty (H-DMEK): results of a donor insertion pull-through technique using donor stroma as carrier

2020 ◽  
Vol 104 (10) ◽  
pp. 1358-1362 ◽  
Author(s):  
Jyh Haur Woo ◽  
Hla Myint Htoon ◽  
Donald Tan
Keyword(s):  
Endothelial Cell ◽  
Case Series ◽  
Cell Loss ◽  
Corneal Dystrophy ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Descemet Membrane ◽  
Pull Through

AimTo evaluate the outcomes and complications of hybrid Descemet membrane endothelial keratoplasty (H-DMEK) using a Descemet stripping automated endothelial keratoplasty (DSAEK) pull-through donor inserter and donor stroma as carrier.MethodsThis was a retrospective interventional case series of eyes with bullous keratopathy (BK) and Fuchs endothelial corneal dystrophy (FECD), which underwent H-DMEK, performed using a bimanual pull-through technique using DSAEK-prepared donor stroma as carrier and the EndoGlide Ultrathin DSAEK donor insertion device. Complex cases with tube shunts, trabeculectomy, aphakia, aniridia, previous vitrectomy, keratoplasty or combined with intraocular lens exchange, were also included. The outcome measures were intraoperative and postoperative complications, best corrected visual acuity (BCVA) and endothelial cell loss after surgery.ResultsOf the 85 eyes from 79 patients, 43.5% (n=37) had BK, 28.2% (n=24) had FECD while 24.7% (n=21) had failed grafts. DMEK was performed in 37 complex eyes (43.5%). Four eyes (4.7%) required rebubbling for graft detachment and two cases of graft failure were observed. A BCVA of 20/25 or better was attained in 44.7% and 57.1% of eyes without pre-existing ocular pathology at 6 and 12 months, respectively. The overall endothelial cell loss was 32.2%±20.5% at 6 months, which improved from 37.2%±20.9% to 24.2%±17.5%, comparing the first 40 and last 45 cases (p=0.012).ConclusionHybrid DMEK offers a controlled ‘pull-through’ technique of donor insertion in the ‘endothelium-in’ configuration, which may be useful especially in complicated eyes. More studies are needed to confirm the long-term endothelial cell loss and graft survival associated with this technique.

Do We Overestimate the Endothelial Cell “Loss” After Descemet Membrane Endothelial Keratoplasty?

2013 ◽  
Vol 38 (2) ◽  
pp. 260-265 ◽  
Author(s):  
Ruth Quilendrino ◽  
Helmut Höhn ◽  
Win Hou W. Tse ◽  
Heng Chi ◽  
Isabel Dapena ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Cell Loss ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Descemet Membrane

scholarly journals Risk factors for endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takahiko Hayashi ◽  
Silvia Schrittenlocher ◽  
Sebastian Siebelmann ◽  
Viet Nhat Hung Le ◽  
Mario Matthaei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endothelial Cell ◽  
Cell Loss ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Descemet Membrane

scholarly journals Quantitative Analysis of Endothelial Cell Loss in Preloaded Descemet Membrane Endothelial Keratoplasty Grafts

Cornea ◽  
2017 ◽  
Vol 36 (11) ◽  
pp. 1295-1301 ◽  
Author(s):  
Meraf A. Wolle ◽  
David L. DeMill ◽  
Lauren Johnson ◽  
Stephen I. Lentz ◽  
Maria A. Woodward ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Quantitative Analysis ◽  
Cell Loss ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Descemet Membrane

scholarly journals Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons

2020 ◽  
Vol 5 (1) ◽  
pp. e000524
Author(s):  
Daniel Pilger ◽  
Necip Torun ◽  
Anna-Karina B Maier ◽  
Jan Schroeter
Keyword(s):  
Endothelial Cell ◽  
Functional Results ◽  
Cell Loss ◽  
Tissue Preparation ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Donor Tissue ◽  
Descemet Membrane ◽  
The Difference ◽  
Corneal Donor Tissue

ObjectiveIncreasingly, cornea banks are recovering donor tissue from pseudophakic donors. Little is known about their suitability for Descemet membrane endothelial keratoplasty (DMEK) surgery in terms of endothelial cell density (ECD) and preparation failure.Methods and AnalysisWe explored ECD during donor tissue preparation in 2076 grafts. Preparation failure was analysed in 1028 grafts used in DMEK surgery at our clinic. To monitor ECD and functional results, we matched 86 DMEK patients who received pseudophakic donor grafts with similar recipients of phakic donor grafts and followed them up for 36 months.ResultsAt recovery, mean ECD in pseudophakic donor grafts was 2193 cells/mm2 (SD 28.7) and 2364 cells/mm2 (SD 15.7) in phakic donor grafts (p<0.001). After cultivation, the difference increased as pseudophakic donor grafts lost 14% of ECD while phakic lost only 6% (p<0.001). At transplantation, mean ECD in pseudophakic donor grafts was 2272 cells/mm2 (SD 250) and 2370 cells/mm2 (SD 204) in phakic donor grafts (p<0.001). After transplantation, the difference in ECD increased as pseudophakic donor grafts lost 27.7% of ECD while phakic donor grafts lost only 13.3% (p<0.001). The risk of preparation failure in pseudophakic donor grafts was higher than in phakic donor grafts (OR 4.75, 95% CI 1.78 to 12.67, p=0.02). Visual acuity increased in both groups similarly.ConclusionsPseudophakic donor grafts have a lower ECD, are more prone to endothelial cell loss during recovery and surgery and are associated with a higher risk of preparation failure. Cornea banks and surgeons should consider this in the planning of graft preparation and transplantation.

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