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Use of Donor Corneas From Pseudophakic Eyes for Descemet Membrane Endothelial Keratoplasty. Cornea 2018; 37:859-862. [DOI: 10.1097/ico.0000000000001589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bramann EL, Schröder K, Schrader S, Geerling G. [Descemetectomy : An alternative to transplantation?]. Ophthalmologe 2017; 114:666-669. [PMID: 28597204 DOI: 10.1007/s00347-017-0516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Due to rising demand worldwide it is becoming increasingly more difficult to satisfy the needs for human corneal transplants. At this point transplantation is the only possible cure for endothelial diseases, such as Fuchs endothelial dystrophy. In this article we present descemetectomy, a circumscribed removal of Descemet's membrane (DMx) without subsequent transplantation, as new possible treatment option on the basis of a clinical case.
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Affiliation(s)
- E L Bramann
- Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - K Schröder
- Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - S Schrader
- Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - G Geerling
- Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Heinzelmann S, Böhringer D, Eberwein P, Lapp T, Reinhard T, Maier P. Descemet membrane endothelial keratoplasty for graft failure following penetrating keratoplasty. Graefes Arch Clin Exp Ophthalmol 2017; 255:979-985. [PMID: 28160068 DOI: 10.1007/s00417-017-3600-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/14/2017] [Accepted: 01/19/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Descemet membrane endothelial keratoplasty (DMEK) is superior to penetrating keratoplasty (PK) in terms of visual rehabilitation, intraoperative safety and risk of rejection. Therefore, it seems reasonable to perform DMEK in eyes with endothelial failure following PK. We herein report our first clinical results. METHODS Nineteen eyes with endothelial graft failure following PK were treated with DMEK. The majority of these eyes (12) had limited visual potential. The major indication for DMEK was pain relief in patients with bullous keratopathy. Visual acuity (VA), central corneal thickness (CCT), rate of graft dislocations, graft survival, graft rejections and other complications were extracted from the medical records. RESULTS Although comorbidities limiting VA were present in 12 of the 19 eyes, VA increased from 0.05 to 0.1 (median) in 16 eyes. CCT decreased substantially (range 63-363 μm). Rebubbling was necessary in five eyes with incomplete graft adherence. There were two immunologic graft reactions and three graft failures. No major complications like endophthalmitis or expulsive bleeding occurred. CONCLUSIONS DMEK is feasible to treat endothelial graft failure following PK. This is even true for eyes with limited visual potential.
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Affiliation(s)
- Sonja Heinzelmann
- Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
| | - Daniel Böhringer
- Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany
| | - Philipp Eberwein
- Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany
| | - Thabo Lapp
- Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany
| | - Thomas Reinhard
- Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany
| | - Philip Maier
- Eye Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany
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Heinzelmann S, Böhringer D, Eberwein P, Reinhard T, Maier P. Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 2016; 255:127-133. [DOI: 10.1007/s00417-016-3499-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/11/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022] Open
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Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 2016; 254:515-22. [DOI: 10.1007/s00417-015-3248-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022] Open
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Linke SJ, Ren L, Frings A, Steinberg J, Wöllmer W, Katz T, Reimer R, Hansen NO, Jowett N, Richard G, Dwayne Miller RJ. [Perspectives of laser-assisted keratoplasty: current overview and first preliminary results with the picosecond infrared laser (λ = 3 µm)]. Ophthalmologe 2015; 111:523-30. [PMID: 24942118 DOI: 10.1007/s00347-013-2995-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This article provides a review of the current state of laser-assisted keratoplasty and describes a first proof of concept study to test the feasibility of a new mid-infrared (MIR) picosecond laser to perform applanation-free corneal trephination. METHODS The procedure is based on a specially adapted laser system (PIRL-HP2-1064 OPA-3000, Attodyne, Canada) which works with a wavelength of 3,000 ± 90 nm, a pulse duration of 300 ps and a repetition rate of 1 kHz. The picosecond infrared laser (PIRL) beam is delivered to the sample by a custom-made optics system with an implemented scanning mechanism. Corneal specimens were mounted on an artificial anterior chamber and subsequent trephination was performed with the PIRL under stable intraocular pressure conditions. RESULTS A defined corneal ablation pattern, e.g. circular, linear, rectangular or disc-shaped, can be selected and its specific dimensions are defined by the user. Circular and linear ablation patterns were employed for the incisions in this study. Linear and circular penetrating PIRL incisions were examined by macroscopic inspection, histology, confocal microscopy and environmental scanning electron microscopy (ESEM) for characterization of the incisional quality. Using PIRL reproducible and stable incisions could be made in human and porcine corneal samples with minimal damage to the surrounding tissue. CONCLUSION The PIRL laser radiation in the mid-infrared spectrum with a wavelength of 3 µm is exactly tuned to one of the dominant vibrational excitation bands of the water molecule, serves as an effective tool for applanation-free corneal incision and might broaden the armamentarium of corneal transplant surgery.
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Affiliation(s)
- S J Linke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
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DMEK in phakic eyes: targeted therapy or highway to cataract surgery? Graefes Arch Clin Exp Ophthalmol 2015; 253:909-14. [DOI: 10.1007/s00417-015-2956-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 11/26/2022] Open
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Heinzelmann S, Maier P, Böhringer D, Hüther S, Eberwein P, Reinhard T. Cystoid macular oedema following Descemet membrane endothelial keratoplasty. Br J Ophthalmol 2014; 99:98-102. [DOI: 10.1136/bjophthalmol-2014-305124] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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[Standardized Descemet membrane endothelial keratoplasty (DMEK): technique and latest results]. Ophthalmologe 2014; 111:1041-9. [PMID: 24763689 DOI: 10.1007/s00347-013-3014-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The procedure of posterior lamellar keratoplasty has now become established as first choice therapy for the treatment of corneal endothelial diseases, with Descemet membrane endothelial keratoplasty (DMEK) as the most recent refinement of endothelial keratoplasty techniques. In this study the outcome of 400 consecutive cases after standardized no-touch DMEK was evaluated. METHODS This was a non-randomized retrospective clinical study of 400 consecutive eyes in 321 patients who underwent standard DMEK. Outcome measures included best corrected visual acuity (BCVA) preoperatively and postoperatively at 1, 3 and 6 months, endothelial cell density (ECD), pachymetry and complications within the first 6 months. In addition two subgroups were analyzed (subgroup I cases 1-200 and subgroup II cases 201-400). RESULTS At 6 months postoperatively 80 % of all eyes had a BCVA of ≥ 20/25 (≥ 0.8), 44 % of ≥ 20/20 (≥ 1.0) and 14 % of ≥ 20/18 (≥ 1.2). There were no significant differences between the two subgroups. The mean ECD preoperatively was 2,542 (± 217) cells/mm(2) and 6 months postoperatively 1,622 (± 500) cells/mm(2). The mean ECD decrease was 36 % 6 months after DMEK. No difference between the subgroups was noted. In 5 % a re-operation was needed of which 75 % were performed in subgroup I. CONCLUSION With the standardized no-touch DMEK technique a rapid and nearly complete visual rehabilitation as well as ECD values similar to earlier endothelial keratoplasty techniques can be achieved. Therefore DMEK may become the preferred treatment for corneal endothelial disorders.
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Cursiefen C, Steven P, Roters S, Heindl LM. [Prevention and management of complications in Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK)]. Ophthalmologe 2014; 110:614-21. [PMID: 23740158 DOI: 10.1007/s00347-012-2679-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Posterior lamellar keratoplasty, in the form of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK), has become a standard procedure for therapy of endothelial diseases of the cornea. The aim of this article is to describe strategies to prevent and manage complications in DMEK and DSAEK surgery. METHODS The article is based on a PubMed literature search and own clinical data. Key words used were "DMEK", "DSAEK", "Descemet membrane endothelial keratoplasty" and "Descemet stripping automated endothelial keratoplasty". RESULTS The DMEK and DSAEK procedures are safe surgical strategies for treating endothelial corneal diseases if the indications are made correctly. CONCLUSIONS The DMEK procedure is the standard procedure for improvement of visual acuity especially for younger patients with Fuchs' dystrophy and DSAEK is particularly suitable for eyes with complicated anterior chamber situations.
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Affiliation(s)
- C Cursiefen
- Universitätsaugenklinik Köln, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
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Heinzelmann S, Böhringer D, Maier PC, Reinhard T. Correlation between visual acuity and interface reflectivity measured by pentacam following DSAEK. Acta Ophthalmol 2014; 92:e1-4. [PMID: 23889769 DOI: 10.1111/aos.12217] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Descemet-stripping automated endothelial keratoplasty (DSAEK) is an advanced method of lamellar endothelial keratoplasty. In comparison with penetrating keratoplasty, visual rehabilitation seems to be faster. Final visual outcome of DSAEK, however, seems to be limited, especially in comparison with Descemet membrane endothelial keratoplasty (DMEK). DSAEK cases without graft failure often do not show any definite correlate for the reduced optical performance. In this study, we tried to correlate visual acuity following DSAEK with interface reflectivity as measured by a rotating Scheimpflug system. METHODS We examined 14 eyes of 13 patients with the pentacam for 2-11 months following DSAEK. Reflectivity of the interface region in the centre of the optical axis as well as central corneal thickness was determined. Statistical correlation between interface reflectivity and best spectacle-corrected visual acuity, central corneal thickness and follow-up time was drawn (multifactorial linear regression analysis). RESULTS Statistically significant correlation between interface reflectivity and BSCVA as well as follow-up time was found. Reflectivity was highest in regions of interface (metal) particles. There was no statistically significant correlation between interface reflectivity and central corneal thickness. CONCLUSION We present a measurable correlate for reduced visual outcome following DSAEK despite a clear graft. Inverse correlation between interface reflectivity and best spectacle-corrected visual acuity (BSCVA) indicates that irregularities or scarring in the interface region may influence the optical quality following DSAEK.
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Maier P, Reinhard T, Cursiefen C. Descemet stripping endothelial keratoplasty--rapid recovery of visual acuity. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:365-71. [PMID: 23795211 DOI: 10.3238/arztebl.2013.0365] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/31/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Technical innovations in corneal transplantation have now made it possible to replace only the diseased part of the cornea, rather than the entire cornea as in penetrating keratoplasty (PKP). Patients with endothelial insufficiency due to Fuchs endothelial dystrophy, bullous keratopathy, or endothelial failure after keratoplasty can be treated with the new methods of posterior lamellar corneal transplantation: Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). It remains unclear which of these methods is better in the individual case. METHODS We review the pertinent literature retrieved by a selective search in Medline and the Cochrane Library employing the terms "DMEK," "DSAEK," "DSEK," and "posterior lamellar keratoplasty." The publications considered in this article are those that contain important clinical information on the operative techniques. RESULTS No randomized controlled trials of these techniques have been published to date. Numerous case series have shown that patients who undergo DSAEK (postoperative visual acuity ≥0.5 in 38-100%), and especially those who undergo it in early or intermediate stages of endothelial insufficiency, achieve a better functional result more rapidly than patients treated with PKP (postoperative visual acuity ≥0.5 in 47-61%). Only 23-47% of DSAEK patients achieve a visual acuity of 0.8 or more, compared to 36-79% of DMEK patients. Moreover, transplant rejection is seen in only 1-3% of cases of DMEK, compared to 0-8% after DSAEK and 1-23% after PKP. CONCLUSION Numerous case series show clear advantages of DMEK over DSAEK, which, in turn, has better results than PKP. Nonetheless, randomized controlled trials are needed to determine which operative method is best in each stage of corneal disease.
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Visual outcome and histological findings following femtosecond laser-assisted versus microkeratome-assisted DSAEK. Graefes Arch Clin Exp Ophthalmol 2013; 251:1979-85. [PMID: 23661098 DOI: 10.1007/s00417-013-2359-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/20/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the visual outcome of femtosecond laser-assisted Descemet stripping automated endothelial keratoplasty (DSAEK) to microkeratome-assisted DSAEK as well as to contrast precut versus surgeon-cut grafts. Histologic characterization of failed DSAEK grafts was performed in order to correlate ultrastructural changes with graft failures. METHODS In this case control study, 47 cases of DSAEK were investigated in terms of visual acuity, keratometric astigmatism, spherical equivalent, endothelial cell count, and postoperative complications. We formed three groups: the femtosecondlaser-assisted DSAEK with precut grafts, the microkeratome-assisted DSAEK with precut and with surgeon-cut grafts. Mean follow-up was 6 months. In the case of graft failure, penetrating keratoplasty was performed, and the excised corneal buttons were investigated by light and electron microscopy. RESULTS Microkeratome-assisted DSAEK lead to better visual outcome than femtosecond laser-assisted DSAEK. Keratometric astigmatism, spherical equivalent and endothelial cell count did not differ significantly between both methods. Precut and surgeon-cut grafts in microkeratome-assisted DSAEK did not show any significant difference regarding all upraised parameters. No definite histological correlate for graft failure following femtosecond laser-assisted DSAEK was found. CONCLUSIONS Femtosecond laser-assisted DSAEK is not the method of choice, and needs further technical improvement. However, failed femtosecondlaser-assisted DSAEK grafts did not show significant histological changes related to the technique to explain reduced visual acuity. In microkeratome-assisted DSAEK, the preparation time point of the graft does not seem to influence the visual and optical outcome.
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Einfluss der Spenderlamellendicke auf die Sehschärfe nach „Descemet’s stripping automated endothelial keratoplasty“ (DSAEK). Ophthalmologe 2013; 111:128-34. [PMID: 23575642 DOI: 10.1007/s00347-013-2795-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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