1
|
Kilian R, Crincoli E, Lammer J, Rizzo C, Pedrotti E, Schmidinger G. Predictive factors for re-bubbling after DMEK: focus on the posterior corneal surface. Graefes Arch Clin Exp Ophthalmol 2024; 262:2181-2187. [PMID: 38326628 DOI: 10.1007/s00417-024-06383-3] [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] [Received: 09/19/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
PURPOSE To understand whether the preoperative morphology of the posterior corneal surface influences the rate of re-bubbling after Descemet membrane endothelial keratoplasty (DMEK). METHODS After retrospectively analyzing the medical records of patients undergoing DMEK, in this multicentric cross-sectional study, we performed a binomial logistic regression analysis to assess significant predictors of re-bubbling and re-transplantation after surgery. Analyzed parameters included the preoperative diagnosis, anterior and posterior surface K1/K2, central corneal thickness, posterior Q value, and other posterior corneal surface parameters evaluated on the elevation maps produced by anterior segment optical coherence tomography. Results were stratified based on the surgeons' experience. RESULTS We included 202 eyes of 202 patients with a mean age of 69.5 ± 12.4 years; 154 eyes were operated by a high-volume surgeon and 48 by one with less experience; 48 eyes (23.8%) underwent ≥ 1 re-bubbling and 14(6.9%) ≥ 1 re-transplantation. The presence of positive/less-negative posterior corneal irregularities and irregularities with greater absolute height had a significantly higher risk of re-bubbling in both the expert and less expert group (OR = 2.85 and 1.42, OR = 3.22 and 3.01, respectively, p < 0.05), whereas more negative posterior K1 and K2 were significant risk factors only in the former group (OR = 0.67 and 0.55, respectively, p < 0.05). Endothelial decompensation other than Fuchs and pseudophakic bullous keratopathy, more negative posterior Q values and smaller distances between center, and the highest/lowest posterior corneal surface irregularity correlated with an increased risk of graft failure (OR 1.23, 1.21, and 1.29, respectively, p < 0.05). CONCLUSION Posterior corneal surface morphology significantly influences the risk of re-bubbling after DMEK.
Collapse
Affiliation(s)
- Raphael Kilian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS," , Rome, Italy.
- Catholic University of "Sacro Cuore," , Rome, Italy.
| | - Jan Lammer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Emilio Pedrotti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gerald Schmidinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
2
|
Kim CY, Yoon CH, Kim MK. Risk factors for early graft detachment requiring rebubbling in Descemet membrane endothelial keratoplasty with imported pre-cut donor tissues. Front Med (Lausanne) 2024; 11:1266049. [PMID: 38390568 PMCID: PMC10881667 DOI: 10.3389/fmed.2024.1266049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
Graft detachment is a common and significant complication in Descemet membrane endothelial keratoplasty (DMEK). We investigated the risk factors of graft detachment requiring rebubbling after DMEK using imported pre-cut donor tissues. The medical records of 48 patients who underwent DMEK for Fuchs' endothelial dystrophy (FED) or bullous keratopathy (BK) at Seoul National University Hospital were retrospectively reviewed. Donor, recipient, and surgical factors were evaluated using univariate and multivariate logistic regression models. Graft detachment requiring rebubbling occurred in 17 (32.7%) eyes. The detachment group exhibited older recipient age (p = 0.006), higher prevalence of diabetes (p = 0.001), and a higher proportion of FED (65%, p = 0.003). Notably, the detachment group demonstrated a significantly lower postoperative 2-h intraocular pressure (IOP) (p = 0.002) and a greater proportion of eyes with IOP <20 mmHg (p < 0.001). Older recipient age (OR 1.08, 95% CI 1.02-1.17), diabetes (OR 23.8, 95% CI 2.61-217), FED surgical indication (OR 6.19, 95% CI 1.74-22.0), lower postoperative 2-h IOP (OR 1.21, 95% CI 1.06-1.38), and postoperative 2-h IOP <20 mmHg (OR 14.0, 95% CI 1.64-119) were associated with increased odds of graft detachment. According to multivariate logistic regression, lower postoperative 2-h IOP (OR 1.23, 95% CI 1.02-1.47) and postoperative 2-h IOP <20 mmHg (OR 25.1, 95% CI 1.05-602) increased the risk of graft detachment. Lower postoperative 2-h IOP, particularly below 20 mmHg, may increase the risk of graft detachment, and diabetes in recipients may pose a higher risk of graft detachment after DMEK.
Collapse
Affiliation(s)
- Chung Young Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Transplantation Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| |
Collapse
|
3
|
Muijzer MB, Delbeke H, Dickman MM, Nuijts RMMA, Jimale H, van Luijk CM, Imhof SM, Wisse RPL. Video Grading of Descemet Membrane Endothelial Keratoplasty Surgery to Identify Surgeon Risk Factors for Graft Detachment and Rebubbling: A Post Hoc Observational Analysis of the Advanced Visualization In Corneal Surgery Evaluation Trial. Cornea 2023; 42:1074-1082. [PMID: 36730371 PMCID: PMC10392889 DOI: 10.1097/ico.0000000000003181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/28/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to explore video-graded intraoperative risk factors for graft detachment (GD) and rebubbling in Descemet membrane endothelial keratoplasty surgery. METHODS A post hoc analysis of 65 eyes of 65 pseudophakic subjects with Fuchs endothelial dystrophy that underwent Descemet membrane endothelial keratoplasty surgery as part of the Advanced Visualization In Corneal Surgery Evaluation trial. All surgical recordings were assessed by 2 graders using a structured assessment form. A multinominal regression was performed to estimate the independent effect of video-graded intraoperative factors on the incidence of GD and rebubbling. Secondary outcomes are corrected distance visual acuity and endothelial cell density. RESULTS In total, 33 GDs were recorded, of which 17 required rebubbling. No significant predictors for GD or rebubbling were identified. However, the results revealed 2 clinically relevant patterns. An unfavorable graft configuration (ie, wrinkled, tight scroll, or taco-shaped) and a gas-bubble size smaller than the graft diameter were associated with an increased risk of GD [odds ratio (OR) 2.5 and OR 2.26, respectively] and rebubbling (OR 2.0 and OR 2.60, respectively). Inversely, a larger gas-bubble size was associated with a reduced risk of GD (OR 0.37) and rebubbling (OR 0.36). At 3 and 6 months postoperatively, corrected distance visual acuity was poorer in subjects requiring a rebubbling and endothelial cell density loss was higher in subjects with a partial GD. CONCLUSIONS Our analysis revealed that the gas-bubble size and graft shape/geometry seem to be relevant clinical factors for GD and rebubbling, whereas descemetorhexis difficulty, degree of graft manipulation, graft overlap, and surgical iridectomy were not associated with an increased risk.
Collapse
Affiliation(s)
- Marc B. Muijzer
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Heleen Delbeke
- Ophthalmology Department, University Hospital Leuven, Leuven, Belgium
- KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research group Ophthalmology; Leuven, Belgium; and
| | - Mor M. Dickman
- University Eye Clinic, Department of Ophthalmology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rudy M. M. A. Nuijts
- University Eye Clinic, Department of Ophthalmology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hanad Jimale
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chantal M. van Luijk
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia M. Imhof
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert P. L. Wisse
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
4
|
Patefield A, Meng Y, Airaldi M, Coco G, Vaccaro S, Parekh M, Semeraro F, Gadhvi KA, Kaye SB, Zheng Y, Romano V. Deep Learning Using Preoperative AS-OCT Predicts Graft Detachment in DMEK. Transl Vis Sci Technol 2023; 12:14. [PMID: 37184500 DOI: 10.1167/tvst.12.5.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Purpose To evaluate a novel deep learning algorithm to distinguish between eyes that may or may not have a graft detachment based on pre-Descemet membrane endothelial keratoplasty (DMEK) anterior segment optical coherence tomography (AS-OCT) images. Methods Retrospective cohort study. A multiple-instance learning artificial intelligence (MIL-AI) model using a ResNet-101 backbone was designed. AS-OCT images were split into training and testing sets. The MIL-AI model was trained and validated on the training set. Model performance and heatmaps were calculated from the testing set. Classification performance metrics included F1 score (harmonic mean of recall and precision), specificity, sensitivity, and area under curve (AUC). Finally, MIL-AI performance was compared to manual classification by an experienced ophthalmologist. Results In total, 9466 images of 74 eyes (128 images per eye) were included in the study. Images from 50 eyes were used to train and validate the MIL-AI system, while the remaining 24 eyes were used as the test set to determine its performance and generate heatmaps for visualization. The performance metrics on the test set (95% confidence interval) were as follows: F1 score, 0.77 (0.57-0.91); precision, 0.67 (0.44-0.88); specificity, 0.45 (0.15-0.75); sensitivity, 0.92 (0.73-1.00); and AUC, 0.63 (0.52-0.86). MIL-AI performance was more sensitive (92% vs. 31%) but less specific (45% vs. 64%) than the ophthalmologist's performance. Conclusions The MIL-AI predicts with high sensitivity the eyes that may have post-DMEK graft detachment requiring rebubbling. Larger-scale clinical trials are warranted to validate the model. Translational Relevance MIL-AI models represent an opportunity for implementation in routine DMEK suitability screening.
Collapse
Affiliation(s)
- Alastair Patefield
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Yanda Meng
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Matteo Airaldi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giulia Coco
- Department of Corneal Diseases, St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sabrina Vaccaro
- Department of Corneal Diseases, St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Ophthalmology, University of "Magna Graecia," Catanzaro, Italy
| | - Mohit Parekh
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Francesco Semeraro
- Ophthalmology Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Kunal A Gadhvi
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Corneal Diseases, St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen B Kaye
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Corneal Diseases, St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Yalin Zheng
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Corneal Diseases, St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Vito Romano
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Corneal Diseases, St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Ophthalmology Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
5
|
Coco G, Levis HJ, Borgia A, Romano D, Pagano L, Virgili G, Kaye SB, Romano V. Posterior stromal ripples increase risk of Descemet's membrane endothelial keratoplasty graft detachment worsening over time. Acta Ophthalmol 2023; 101:e205-e214. [PMID: 36120722 DOI: 10.1111/aos.15250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/14/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate anterior segment optical coherence tomography (AS-OCT) features of Descemet's membrane endothelial keratoplasty (DMEK) grafts associated with graft attachment worsening over time. METHODS Retrospective case series on patients who received uncomplicated DMEK surgery and for whom subsequent AS-OCT data were available for analysis. Patients' demographics and surgical details were collected. AS-OCT was analysed for graft detachment axial extension, presence of posterior stromal ripples, quadrant involvement (location and number), degree of detachment extension, peripheral roll, presence and amount of air in the anterior chamber (AC). Features associated with re-bubbling and graft detachment worsening over time were identified. RESULTS A total of 147 patients with a mean age of 70.8 ± 9.8 years (63% females) were included. AS-OCT was performed at 2.9 ± 2.4 days after surgery. AS-OCT factors associated with re-bubbling were posterior stromal ripples (p = 0.004) and detachment axial extension (p < 0.001). At first follow-up, of the 147 DMEK, 67 showed complete attachment and 80 partial detachment. In those cases of initially completely attached grafts, posterior stromal ripples were associated with the risk of subsequent graft detachment (p = 0.014) together with recipient age (p = 0.043), phaco-combined surgery (p = 0.018) and AS-OCT timing (p = 0.033); while, in the initially partially detached grafts, detachment worsening was associated with posterior stromal ripples (p = 0.025), detachment axial extension (p = 0.003), degrees of detachment involvement (p = 0.029), peripheral roll-in shape (p = 0.033) and presence of air in the AC (p = 0.032). Relative risk (RR) of graft detachment worsening in patients with moderate/severe posterior stromal ripples was 1.75 (95% CI = 1.09-2.81). CONCLUSION Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time, and patients showing these features should be monitored closely to identify the need for re-bubbling at an early stage, thus improving surgical outcomes.
Collapse
Affiliation(s)
- Giulia Coco
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hannah J Levis
- Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Alfredo Borgia
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Davide Romano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Luca Pagano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Ophthalmology Clinic, University of Firenze and AOU Careggi, Florence, Italy
| | - Stephen B Kaye
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy
| |
Collapse
|
6
|
Dunker S, Winkens B, van den Biggelaar F, Nuijts R, Kruit PJ, Dickman M. Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study. Br J Ophthalmol 2023; 107:17-23. [PMID: 33597192 PMCID: PMC9763158 DOI: 10.1136/bjophthalmol-2020-317041] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/07/2020] [Accepted: 01/26/2021] [Indexed: 11/04/2022]
Abstract
AIMS To identify risk factors for rebubbling, and early graft failure after Descemet membrane endothelial keratoplasty (DMEK). METHODS In this prospective registry study, all consecutive DMEK procedures registered in the Netherlands Organ Transplant Registry were assessed (n=752). Univariable and multivariable analysis was performed using logistic regression. The effect of rebubbling on endothelial cell density was analysed using a linear mixed model. RESULTS 144 of 752 (19%) eyes underwent rebubbling. Rebubbling was successful in 101 eyes (70%). In eyes that underwent rebubbling, the graft failure rate was significantly higher than eyes that did not undergo rebubbling (30% vs 9%, respectively; OR: 4.28, 95% CI 2.72 to 6.73, p<0.001). In multivariable analysis, independent risk factors for rebubbling were surgical complication (OR: 2.28, 95% CI 1.20 to 4.33, p=0.012) and older recipient age (OR: 1.04 (per increase of 1 year), 95% CI 1.01 to 1.07, p=0.003). Risk factors for developing graft failure within 3 months were transplant before 2016 (OR: 3.32, 95% CI 1.87 to 5.90, p<0.001), and surgical complication (OR: 2.93, 95% CI 1.42 to 6.04, p=0.004). Throughout the study period, rebubbling and early graft failure were inversely related. Eyes that underwent rebubbling showed significantly lower endothelial cell densities at 3, 6 and 12 months compared with eyes that did not undergo rebubbling (all p<0.001). CONCLUSIONS This Dutch registry study identified independent risk factors for DMEK graft detachment leading to rebubbling, namely recipient age and surgical complication, and early graft failure, namely transplantation before 2016 and surgical complication. Rebubbling was associated with significantly higher endothelial cell loss in the first year after surgery.
Collapse
Affiliation(s)
- Suryan Dunker
- University Eye Clinic, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Rudy Nuijts
- University Eye Clinic, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Pieter Jan Kruit
- Euro Tissue Bank - Bio Implant Service (ETB-BISLIFE), Leiden, The Netherlands
| | - Mor Dickman
- University Eye Clinic, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | |
Collapse
|
7
|
Kramer N, Unterlauft JD, Girbardt C. The need of rebubbling in case of small graft detachments after Descemet Membrane Endothelial Keratoplasty (DMEK). Eur J Ophthalmol 2022; 33:1347-1353. [PMID: 36536596 PMCID: PMC10152212 DOI: 10.1177/11206721221146579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To investigate the need of rebubbling for small graft detachments after Descemet Membrane Endothelial Keratoplasty (DMEK). Methods In this retrospective study we evaluated 111 eyes from 111 patients that showed graft detachment after DMEK surgery and have achieved graft adherence by injection of air or 20% sulfur hexafluoride (SF6) to the anterior chamber (rebubbling group; n = 57) or by spontaneous adherence without intervention (control group; n = 54) at final examination. Subgroups in terms of the maximum height and in terms of the detachment area in relation to graft area were formed. Outcome measures were the increase in best-corrected visual acuity (BCVA) and the decrease in central corneal thickness (CCT) from the measurement before DMEK to six months after surgery and postoperative endothelial cell density. Results BCVA increased in the rebubbling group and the control group, the difference being 0.22 logMAR, p = 0.048. For eyes with a maximum height less than 500 µm, the increase of BCVA was 0.39 ± 0,36 logMAR in the control group and 0.62 ± 0,53 logMAR in the rebubbling group, p = 0.045. There was no difference of statistical significance of BCVA between both groups regarding the detachment area of less than 20% in relation to graft area. The mean decrease in CCT and postoperative endothelial cell density showed no significant difference between the rebubbling group and the control group. Conclusion Compared to spontaneous graft adherence, a rebubbling shows no beneficial effect on the clinical outcome for small detached DMEK grafts. Rebubbling does not decrease postoperative endothelial cell density.
Collapse
Affiliation(s)
- Nane Kramer
- Department of Ophthalmology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Christian Girbardt
- Department of Ophthalmology, University of Leipzig Medical Center, Leipzig, Germany
| |
Collapse
|
8
|
Guindolet D, Disegni H, Martin GC, Azar G, Hardy S, Cochereau I, Gabison EE. Predictive factors of graft detachment and rebubbling after descemet membrane endothelial keratoplasty. Int Ophthalmol 2022; 43:1511-1521. [PMID: 36463376 DOI: 10.1007/s10792-022-02547-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE To identify risk and predictive factors associated with the need of rebubbling in the eye of patients who underwent a descemet membrane endothelial keratoplasty (DMEK). METHODS The records of patients who underwent DMEK were retrospectively analyzed. Data regarding comorbidities, intraoperative characteristics, and postoperative treatments or complications were collected. The central corneal thickness (CCT) was measured by optical coherence tomography before and the day after DMEK. Univariate and multivariate analyses were performed. RESULTS Of the 333 DMEK, rebubbling was performed in 119 cases (36%). Preoperative subepithelial fibrosis and a history of penetrating keratoplasty (PK) were associated with significantly more graft detachment [OR of 3.55 (2.02-6.32; P < 0.001) and 5.89 (2.00-21.86; P = 0.003), respectively]. A decreased CCT the day after surgery reduced by 5.7-fold the risk of rebubbling (sensitivity/specificity of 0.42/0.93). Conversely, a 20% increase in the CCT the day after surgery increased by 4.5-fold the risk of rebubbling (sensitivity/specificity of 0.42/0.91). CONCLUSION Variation of the CCT could be used as a predictive factor of rebubbling after DMEK. Patients with a 20% increase of CCT the day after surgery are at higher risk of graft detachment. Conversely, a reduced CCT the day after the surgery is associated with a reduced risk of rebubbling. Subepithelial fibrosis and history of PK were also identified as risk factors for rebubbling. Those predictive factors may help develop a customized approach for patients undergoing DMEK surgery.
Collapse
|
9
|
Ong HS, Htoon HM, Ang M, Mehta JS. “Endothelium-Out” and “Endothelium-In” Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Insertion Techniques: A Systematic Review With Meta-Analysis. Front Med (Lausanne) 2022; 9:868533. [PMID: 35775001 PMCID: PMC9237218 DOI: 10.3389/fmed.2022.868533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated the visual outcomes and complications of “endothelium-out” and “endothelium-in” Descemet membrane endothelial keratoplasty (DMEK) graft insertion techniques. Materials and Methods Electronic searches were conducted in CENTRAL, Cochrane databases, PubMed, EMBASE, ClinicalTrials.gov. Study designs included clinical trials, comparative observational studies, and large case series (≥25 eyes). PRISMA guidelines were used for abstracting data and synthesis. Random-effects models were employed for meta-analyses. Results 21,323 eyes (95 studies) were included. Eighty-six studies reported on “endothelium-out” techniques; eight studies reported on “endothelium-in” techniques. One study compared “endothelium-out” to “endothelium-in” techniques. Eighteen “endothelium-out” studies reported that 42.5–85% of eyes achieved best-corrected visual acuity (BCVA) ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 58.7% (95% CI 49.4–67.7%,15 studies). Three “endothelium-in” studies reported that 44.7–87.5% of eyes achieved BCVA of ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 62.4% (95% CI 33.9–86.9%). Pooled mean endothelial cell loss was lower in the “endothelium-in” studies (28.1 ± 1.3%, 7 studies) compared to “endothelium-out” studies (36.3 ± 6.9%,10 studies) at 6 months (p = 0.018). Graft re-bubbling rates were higher in the “endothelium-out” studies (26.2%, 95% CI 21.9–30.9%, 74 studies) compared to “endothelium-in” studies (16.5%, 95% CI 8.5–26.4%, 6 studies), although statistical significance was not reached (p = 0.440). Primary graft failure rates were comparable between the two groups (p = 0.552). Quality of evidence was considered low and significant heterogeneity existed amongst the studies. Conclusion Reported rates of endothelial cell loss were lower in “endothelium-in” DMEK studies at 6 months compared to “endothelium-out” studies. Outcomes of “endothelium-in” techniques were otherwise comparable to those reported in “endothelium-out” studies. Given the technical challenges encountered in “endothelium-out” procedures, surgeons may consider “endothelium-in” techniques designed for easier intra-operative DMEK graft unfolding. “Endothelium-in” studies evaluating outcomes at longer time points are required before conclusive comparisons between the two techniques can be drawn.
Collapse
Affiliation(s)
- Hon Shing Ong
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Hon Shing Ong,
| | - Hla M. Htoon
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Ang
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Jodhbir S. Mehta,
| |
Collapse
|
10
|
Malleron V, Bloch F, Zevering Y, Vermion JC, Semler-Collery A, Goetz C, Perone JM. Evolution of corneal transplantation techniques and their indications in a French corneal transplant unit in 2000–2020. PLoS One 2022; 17:e0263686. [PMID: 35486609 PMCID: PMC9053824 DOI: 10.1371/journal.pone.0263686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/24/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose This retrospective cohort study assessed the evolution of corneal transplantation and its indications in the last 21 years (2000–2020) in a specialized ophthalmology department in a tertiary referral center in France. Methods The surgical techniques and indications, patient age and sex, and postoperative best-corrected visual acuity (BCVA) 6 months after keratoplasty were extracted. Results In total, 1042 eyes underwent keratoplasty in 2000–2020. Annual numbers of corneal transplantations increased by 2.2-fold. Penetrating keratoplasty (PKP) was the sole technique for the first 11 years. Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) were introduced in 2011 and 2014, respectively. Cases of both quickly increased, accounting for 28% and 41% of cases in 2015–2020, respectively. Eventually, DSAEK and DMEK were respectively used for most pseudophakic bullous keratopathy (PBK) and all Fuchs endothelial cell dystrophy (FECD) cases. PKP cases declined to 27%. Deep anterior lamellar keratoplasty (DALK) was rare (3% of all cases). These changes associated with rises in PBK and particularly FECD cases, and a strong decline in keratoconus, causing FECD, PBK, and keratoconus to move from being the 4th, 1st, and 3rd most common indications to the 1st, 2nd, and 6th, respectively. On average, BCVA improved by 0.1–0.3 logMAR. Patient age dropped steadily over time. Female predominance was observed. Conclusions The invention of DSAEK and then DMEK precipitated an enormous change in clinical practice and a large expansion of keratoplasty to new indications. This study confirms and extends previous findings in other countries.
Collapse
Affiliation(s)
- Vianney Malleron
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Florian Bloch
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Yinka Zevering
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Jean-Charles Vermion
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Axelle Semler-Collery
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Christophe Goetz
- Research Support Unit, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Jean-Marc Perone
- Institut Jean Lamour, Lorraine University, Nancy, France
- * E-mail:
| |
Collapse
|
11
|
Chaussard D, Bloch F, Elnar AA, Zevering Y, Vermion JC, Moskwa R, Perone JM. Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study. PLoS One 2022; 17:e0264401. [PMID: 35202443 PMCID: PMC8870504 DOI: 10.1371/journal.pone.0264401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015–2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding.
Collapse
Affiliation(s)
- Dimitri Chaussard
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Florian Bloch
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Arpiné Ardzivian Elnar
- Clinical Research Support Unit, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville Regional Hospital Center, Metz, France
| | - Yinka Zevering
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Rémi Moskwa
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
- Institut Jean Lamour, Lorraine University, Nancy, France
- * E-mail:
| |
Collapse
|
12
|
Beşek NK, Yalçınkaya G, Kırgız A, Çakmak S, Genç S, Nacaroğlu ŞA, Yıldız BK, Yıldırım Y, Ağca A. Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results. Int Ophthalmol 2021; 42:269-279. [PMID: 34637061 DOI: 10.1007/s10792-021-02078-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim is to report long-term graft survival rates and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK). METHODS In this study 150 eyes that underwent DMEK whether for Fuchs endothelial corneal dystrophy (FECD) or for bullous keratopathy (BK) surveilled for 7 years at 6 time points to evaluate graft survival rates and clinical outcomes of post-corneal transplantation. RESULTS Overall, the estimated survival probability of 95% confidence interval at 7 years of post-DMEK was 0.58 (0.72-0.77), and the survival probabilities of eyes operated for FECD (0.53) were higher than eyes operated for BK (0.42) (log rank 26.87, [p = 0.197]). Post-transplant eyes with FECD achieved better visual acuity levels than eyes with BK (p = 0.006). Primary graft failure occurred in 11.3% eyes. Secondary graft failure rate was 9.3%, and allograft rejection rate was 4.7%. CONCLUSION Although DMEK is effective and safe in long term, visual results and graft survival rates are better in cases with FECD.
Collapse
Affiliation(s)
- Nilay Kandemir Beşek
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey.
| | - Gülay Yalçınkaya
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Ahmet Kırgız
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Semih Çakmak
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Selim Genç
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Şenay Aşık Nacaroğlu
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Burçin Kepez Yıldız
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Yusuf Yıldırım
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Alper Ağca
- Department of Ophthalmology, Ataköy Dünya Eye Hospital, Istanbul, Turkey
| |
Collapse
|
13
|
Corneal pachymetry by AS-OCT after Descemet's membrane endothelial keratoplasty. Sci Rep 2021; 11:13976. [PMID: 34234179 PMCID: PMC8263705 DOI: 10.1038/s41598-021-93186-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
Corneal 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.
Collapse
|
14
|
Achiron A, Nahum Y, Tiosano A, Shehadeh Mashor R, Tuuminen R, Elbaz U, Bahar I, Livny E. Descemet Membrane Endothelial Keratoplasty Outcomes between Young and Old Graft Recipients. Curr Eye Res 2021; 46:1460-1466. [PMID: 33840319 DOI: 10.1080/02713683.2021.1899245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluated Descemet's membrane endothelial keratoplasty (DMEK) outcomes in young and old graft recipients.Materials and Methods: Data of 164 surgeries with a median age of 76 years (interquartile range 14 years) undergoing DMEK surgery between 2016 and 2018 was reviewed. Complications, graft survival, and visual acuity gain were compared between subjects in the 25th percentile (young recipients; aged 70 years and less, n = 21) and 75th percentile (old recipients; aged 85 years and over, n = 27) over the 2-year follow-up.Results: Young recipients had a lower rate of pre-operative glaucoma (14.3% vs. 51.9%, p = .014) and pseudophakic bullous keratopathy (9.5% vs. 59.3%, p < .001), and a higher rate of Fuchs endothelial dystrophy (57.1% vs. 14.8%, p = .002) and combined cataract extraction at the time of DMEK surgery (52.4% vs. 7.4%, p = .001) when compared to old recipients. Complications (primary graft failure, pupillary block, cystoid macular edema or infectious keratitis) were independent of graft recipient age. Descemet's membrane detachment requiring re-bubbling was observed more often in young compared to the old recipients (42.9% vs. 14.8%, p = .049). Visual acuity gain between the groups remained comparable up to 1-year, whereas at 2-years old recipients showed significantly declined visual acuity gains compared to the young recipients (0.14 ± 0.68 vs. 0.74 ± 0.49, p = .012). Graft recipients aged over 85 years had a considerably higher graft failure rate over the 24-months (40.7% vs. 4.8%, p = .006) and shorter graft survival time (p = .002; log-rank) when compared to the recipients aged under 70 years. After adjusting for potential confounders such as Fuchs endothelial dystrophy, pseudophakic bullous keratopathy and glaucoma, the recipients aged over 85 remained at higher risk for graft failure (HR = 17.278, 95% CI = 1.787-167.1, p = .014).Conclusions: In aged DMEK recipients, regardless of the low incidence of early postoperative complications, the rate of postoperative graft failure was significantly higher and graft survival shorter than in younger recipients.
Collapse
Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Tiosano
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | | | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Deshmukh R, Nair S, Ting DSJ, Agarwal T, Beltz J, Vajpayee RB. Graft detachments in endothelial keratoplasty. Br J Ophthalmol 2021; 106:1-13. [PMID: 33397659 DOI: 10.1136/bjophthalmol-2020-318092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022]
Abstract
Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.
Collapse
Affiliation(s)
- Rashmi Deshmukh
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sridevi Nair
- Department of Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, India
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tushar Agarwal
- Department of Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, India
| | - Jacqueline Beltz
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Rasik B Vajpayee
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia .,Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Vision Eye Institute Ltd, Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Heslinga FG, Alberti M, Pluim JPW, Cabrerizo J, Veta M. Quantifying Graft Detachment after Descemet's Membrane Endothelial Keratoplasty with Deep Convolutional Neural Networks. Transl Vis Sci Technol 2020; 9:48. [PMID: 32884855 PMCID: PMC7445365 DOI: 10.1167/tvst.9.2.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose We developed a method to automatically locate and quantify graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) in anterior segment optical coherence tomography (AS-OCT) scans. Methods A total of 1280 AS-OCT B-scans were annotated by a DMEK expert. Using the annotations, a deep learning pipeline was developed to localize scleral spur, center the AS-OCT B-scans and segment the detached graft sections. Detachment segmentation model performance was evaluated per B-scan by comparing (1) length of detachment and (2) horizontal projection of the detached sections with the expert annotations. Horizontal projections were used to construct graft detachment maps. All final evaluations were done on a test set that was set apart during training of the models. A second DMEK expert annotated the test set to determine interrater performance. Results Mean scleral spur localization error was 0.155 mm, whereas the interrater difference was 0.090 mm. The estimated graft detachment lengths were in 69% of the cases within a 10-pixel (∼150 µm) difference from the ground truth (77% for the second DMEK expert). Dice scores for the horizontal projections of all B-scans with detachments were 0.896 and 0.880 for our model and the second DMEK expert, respectively. Conclusions Our deep learning model can be used to automatically and instantly localize graft detachment in AS-OCT B-scans. Horizontal detachment projections can be determined with the same accuracy as a human DMEK expert, allowing for the construction of accurate graft detachment maps. Translational Relevance Automated localization and quantification of graft detachment can support DMEK research and standardize clinical decision-making.
Collapse
Affiliation(s)
- Friso G Heslinga
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Mark Alberti
- Ophthalmology Department, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Josien P W Pluim
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Javier Cabrerizo
- Ophthalmology Department, Rigshospitalet - Glostrup, Copenhagen, Denmark.,Copenhagen Eye Foundation, Copenhagen, Denmark
| | - Mitko Veta
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| |
Collapse
|
17
|
Native means of graft stabilization: Host descemetic scaffolding and wound scaffolding to decrease the risk for graft detachment in DMEK and PDEK. J Cataract Refract Surg 2019; 45:1059-1063. [DOI: 10.1016/j.jcrs.2019.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/20/2022]
|
18
|
Effect of Graft Shift Direction on Graft Detachment and Endothelial Cell Survival After Descemet Membrane Endothelial Keratoplasty. Cornea 2019; 38:970-975. [DOI: 10.1097/ico.0000000000002015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Influence of Intraoperative Air Tamponade Time on Graft Adherence in Descemet Membrane Endothelial Keratoplasty. Cornea 2018; 38:166-172. [DOI: 10.1097/ico.0000000000001795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Descemet Membrane Endothelial Keratoplasty for Failed Penetrating Keratoplasty: Visual Outcomes and Graft Survival. Cornea 2018; 38:151-156. [DOI: 10.1097/ico.0000000000001763] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Influence of Postoperative Intraocular Pressure on Graft Detachment After Descemet Membrane Endothelial Keratoplasty. Cornea 2018; 37:1347-1350. [DOI: 10.1097/ico.0000000000001677] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Brockmann T, Brockmann C, Maier AKB, Schroeter J, Bertelmann E, Torun N. Primary Descemet’s Membrane Endothelial Keratoplasty for Fuchs Endothelial Dystrophy versus Bullous Keratopathy: Histopathology and Clinical Results. Curr Eye Res 2018; 43:1221-1227. [DOI: 10.1080/02713683.2018.1490773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tobias Brockmann
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Claudia Brockmann
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna-Karina B. Maier
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan Schroeter
- Institute of Transfusion Medicine, University Tissue Bank, Charité – Universitätsmedizin Berlin, corporatemember of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Necip Torun
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
23
|
Röck T, Bartz-Schmidt KU, Röck D. Trends in corneal transplantation at the University Eye Hospital in Tübingen, Germany over the last 12 years: 2004 - 2015. PLoS One 2018; 13:e0198793. [PMID: 29939996 PMCID: PMC6016935 DOI: 10.1371/journal.pone.0198793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/25/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose This study aimed to investigate the trends in the surgical methods and leading indications for corneal transplantations carried out over the last 12 years. Methods The data from the corneal graft waiting list and from all keratoplasties carried out between 2004 and 2015 at the University Eye Hospital in Tübingen were retrospectively analyzed. Results A total of 1,185 keratoplasties were performed between 2004 and 2015 at this hospital. The most common surgical indications for corneal transplantation were Fuchs’ endothelial corneal dystrophy (35.2%) and keratoconus (18.9%) with keratoconus being the leading cause during early years (from 2004 to 2009) and Fuch’s dystrophy being the leading cause from 2010 to 2015. Overall, the total count of performed keratoplasties increased, from 385 corneal transplantations during the first 6-year period to 800 corneal transplantations during the second 6-year period (P = 0.008, using Mann-Whitney test). The Descemet’s membrane endothelial keratoplasty has become the favored surgical method for endothelial disorders with the number of Descemet’s membrane endothelial keratoplasties increasing significantly from 2008 to 2015. This increasing trend was statistically significant (P < 0.001 using multivariate adaptive regression splines (MARS). A decreasing trend was also noted for the rate of penetrating keratoplasty since 2008 (P < 0.001 using MARS). Conclusions This research showed major changes in the preferred corneal transplantation techniques and leading indications for keratoplasty over the last 12 years. More importantly, it seems that the rapid development and implementation of endothelial keratoplasty, especially the Descemet’s membrane endothelial keratoplasty, has had a profound effect on and begun a new era in corneal transplantation.
Collapse
Affiliation(s)
- Tobias Röck
- Centre for Ophthalmology, Eberhard-Karls-University Tübingen, Tübingen, Germany
- * E-mail:
| | | | - Daniel Röck
- Centre for Ophthalmology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| |
Collapse
|
24
|
Descemet's Membrane Endothelial Keratoplasty. Indication, technique chirurgicale, gestion postopératoire et revue de la littérature. J Fr Ophtalmol 2018; 41:368-381. [DOI: 10.1016/j.jfo.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
|
25
|
Santander-García D, Dapena I, Baydoun L, Melles GRJ. DMEK complications: current treatment and recommendations. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diana Santander-García
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Gerrit R. J. Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans Eye Bank Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
26
|
Röck T, Landenberger J, Bramkamp M, Bartz-Schmidt KU, Röck D. The Evolution of Corneal Transplantation. Ann Transplant 2017; 22:749-754. [PMID: 29242495 PMCID: PMC6248302 DOI: 10.12659/aot.905498] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the evolution of surgical methods in and leading indications for corneal transplantation from 2005 to 2016. Material/Methods Data from the corneal graft waiting list and from all keratoplasties carried out between 2005 and 2016 at the University Eye Hospital Tübingen were retrospectively evaluated. Results A total of 1259 keratoplasties were performed between 2005 and 2016 at the University Eye Hospital Tübingen. The most common surgical indications for corneal transplantation were Fuchs endothelial corneal dystrophy (45.5%) and keratoconus (14.2%). The mean rate of corneal transplantations almost doubled from 71 keratoplasties per year in the first 6-year period to 139 keratoplasties per year in the second 6-year period (P=0.005). The number of penetrating keratoplasties remained similar. The number of Descemet membrane endothelial keratoplasties (DMEK) increased significantly from 2008 to 2016 (P<0.0001). One DMEK procedure was performed in 2008 (representing 1.4% of all transplantations), while 75 DMEK procedures were performed in 2016 (representing 60.5% of all transplantations) (P<0.0001). DMEK became the favored surgical method for endothelial disorders, exceeding penetrating keratoplasty in 2013. Conclusions Our study shows evolutionary changes in preferred corneal transplantation techniques and leading indications for keratoplasty from 2005 to 2016. Since its introduction a decade ago, DMEK is currently the golden standard in the management of corneal endothelial dysfunction.
Collapse
Affiliation(s)
- Tobias Röck
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Matthias Bramkamp
- Department of General Medicine, Ruhr-University Bochum, Bochum, Germany
| | | | - Daniel Röck
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| |
Collapse
|
27
|
Mechels KB, Greenwood MD, Sudhagoni RG, Berdahl JP. Influences on rebubble rate in Descemet's membrane endothelial keratoplasty. Clin Ophthalmol 2017; 11:2139-2144. [PMID: 29255344 PMCID: PMC5722014 DOI: 10.2147/opth.s147217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Descemet’s membrane endothelial keratoplasty (DMEK) is a minimally invasive partial corneal transplant procedure used in patients with failing endothelial membranes. This study aims to identify those factors which influence the need for a rebubble of the corneal graft. Methods A total of 94 eyes that received DMEK between March 2014 and January 2016 at Vance Thompson Vision were used in the study. Demographic and graft data were collected from the patients and donors, and perioperative statistics of the procedures. A logistical regression was used to compare eyes that did and did not require a rebubble. Results Among those characteristics that were included (patient age/sex, donor age/sex, death to processing time, donation to surgery time, death to procurement time, specular cell count density, burping procedure, postoperative day 1 intraocular pressure [IOP], and postoperative week 1 IOP, concurrent phacoemulsification, and how well the Descemet graft was centered), only a lower specular cell count density of the corneal graft, and a graft that was not well-centered correlated with needing a rebubble due to partial graft detachment (p=0.021) and (p=0.023), respectively. Conclusion An increased specular cell count density may allow for better placement of the corneal graft by allowing for better unfolding in DMEK procedures. A well-centered graft may decrease postoperative complications by increasing adherence. Additionally, postoperative management of IOP may not affect the rebubble rate, and therefore should be left to the discretion of the provider to determine whether it is necessary.
Collapse
Affiliation(s)
- Keegan B Mechels
- Sanford School of Medicine, University of South Dakota, Vermillion, SD
| | | | - Ramu G Sudhagoni
- School of Health Sciences, University of South Dakota, Vermillion, SD, USA
| | | |
Collapse
|
28
|
Meta-Analysis of Postoperative Outcome Parameters Comparing Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2017; 36:1445-1451. [DOI: 10.1097/ico.0000000000001384] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF, Weikert MP, Shtein RM. Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology 2017; 125:295-310. [PMID: 28923499 DOI: 10.1016/j.ophtha.2017.08.015] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction. METHODS Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment. RESULTS After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%-47%) at 6 months. Overall change in spherical equivalent was +0.43 diopters (D; range, -1.17 to +1.2 D), with minimal induced astigmatism of +0.03 D (range, -0.03 to +1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%-76%). Intraocular pressure elevation was the second most common complication (range, 0%-22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%-12.5%), secondary graft failure (mean, 2.2%; range, 0%-6.3%), and immune rejection (mean, 1.9%; range, 0%-5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet's stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%-82%), endothelial rejection (mean, 10%; range, 0%-45%), and primary graft failure (mean, 5%; range, 0%-29%). Mean EC loss after DSEK was 37% at 6 months. CONCLUSIONS The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK.
Collapse
Affiliation(s)
- Sophie X Deng
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - W Barry Lee
- Piedmont Hospital and Eye Consultants of Atlanta, Atlanta, Georgia
| | | | - Anthony N Kuo
- Duke Eye Center, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Y Li
- UC Davis Eye Center, University of California, Davis, Sacramento, California
| | | | | | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Role of Initial Intraocular Pressure in Graft Adhesion After Descemet Membrane Endothelial Keratoplasty. Cornea 2017; 36:7-10. [DOI: 10.1097/ico.0000000000001055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Influence of Ultrastructural Corneal Graft Abnormalities on the Outcome of Descemet Membrane Endothelial Keratoplasty. Am J Ophthalmol 2016; 169:58-67. [PMID: 27318075 DOI: 10.1016/j.ajo.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate if ultrastructural alterations in the Descemet membrane (DM) are correlated with the clinical outcome after Descemet membrane endothelial keratoplasty (DMEK). DESIGN Retrospective cohort study. METHODS setting: Institutional, single-center. STUDY POPULATION One hundred and twelve residual DM specimens obtained after DM stripping. MAIN OUTCOME MEASURES Incidence of ultrastructural abnormalities in transmission electron microscopy, graft detachment rate, graft failure rate, best-corrected visual acuity (BCVA), endothelial cell density (ECD), and central corneal thickness (CCT). Examination dates were on the day before DMEK and 1, 3, 6, and 12 months after surgery. RESULTS Abnormalities in the ultrastructure of DM were found in 16 of 112 specimens (14%) (abnormal DM group), comprising deposits of long-spacing collagen, fine filaments (proteoglycans), a posterior collagenous layer, pseudoexfoliative material, and guttae. The secondary graft failure rate was significantly higher in the abnormal DM group compared with the normal DM group (P = .001). There was a trend for an increased graft detachment rate in the abnormal DM group (11/16) compared with the normal DM group (42/96) (P = .103). There was no significant difference in mean CCT and ECD after surgery. Mean CCT in the eyes with graft failure in the abnormal DM group at the last follow-up before regrafting was 850 μm, indicating endothelial failure with stromal edema. CONCLUSION This study reveals a correlation between ultrastructural alterations of DM in donor corneas and the graft failure rate after DMEK. Thus, graft failure after DMEK not only is determined by surgical trauma and postoperative events but may also be influenced by intrinsic, graft-specific features.
Collapse
|