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Vasiliauskaite I, Kocaba V, van Dijk K, Baydoun L, Lanser C, Lee D, Jager MJ, Melles GRJ, Oellerich S. Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Disease Severity. Cornea 2023; 42:1229-1239. [PMID: 36731083 DOI: 10.1097/ico.0000000000003130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate clinical outcomes and graft survival in a large patient cohort up to 10 years after Descemet membrane endothelial keratoplasty (DMEK) based on surgical indication and Fuchs endothelial corneal dystrophy (FECD) severity. METHODS The cohort in this retrospective study included 750 eyes that underwent DMEK for FECD (86%), bullous keratopathy (BK, 9%), and other indications (5%). Based on the modified Krachmer grading, 186 eyes (29%) had moderate FECD (Krachmer grade 3-4) and 440 eyes (68%) had advanced FECD (Krachmer grade 5-6). Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density (ECD), endothelial cell loss (ECL), postoperative complication rate, and graft survival. RESULTS The mean 10-year BCVA was 0.08 ± 0.28 logMAR (n = 96), and the BCVA remained stable between 5 and 10 years postoperatively (all P > 0.05). The mean ECL at 5 and 10 years was 56% ± 17% (n = 460) and 66% ± 14% (n = 96), respectively ( P < 0.05). The 10-year graft survival rate for the total cohort was 0.85 (95% confidence interval, 0.82-0.89). BCVA and ECD differed at 1 to 5 years between eyes with different surgical indications (all P < 0.05), and FECD eyes had higher graft survival compared with BK eyes (0.90 vs. 0.60, P = 0.001). Moderate FECD eyes had better BCVA, ECD, and graft survival outcomes than advanced FECD eyes (all P < 0.05). Minor graft detachment ( P = 0.04) and lower donor ECD ( P = 0.01) were related to lower 10-year ECD. CONCLUSIONS Long-term outcomes and graft survival after DMEK were better in FECD eyes than BK eyes and were also related to FECD disease severity. Eyes operated for moderate FECD showed the highest graft survival probability and excellent long-term outcomes.
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Affiliation(s)
- Indre Vasiliauskaite
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Viridiana Kocaba
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands
- Tissue and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Korine van Dijk
- 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
- University Eye Hospital Munster, Munster, Germany; and
- ELZA Institute Dietikon/Zurich, Switzerland
| | - Charlotte Lanser
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Demi Lee
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
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Berg K, Safi T, Seitz B, Daas L. Non-invasive endothelial cell density measurement of in toto pre-stripped DMEK-roll - impact of pre- and intraoperative endothelial cell loss on postoperative midterm clinical outcome. Eye (Lond) 2023; 37:2956-2962. [PMID: 36813996 PMCID: PMC10516950 DOI: 10.1038/s41433-023-02450-x] [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: 05/15/2022] [Revised: 01/13/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND/OBJECTIVES To measure the endothelial cell density (ECD) of the in toto pre-stripped endothelial Descemet membrane lamellae (EDML) and to describe the impact of pre- and intraoperative endothelial cell loss (ECL) on postoperative midterm clinical outcome. SUBJECTS/METHODS The ECD of 56 Corneoscleral Donor Discs (CDD) was first measured with an inverted specular microscope (t0pre). The measurement was then repeated non-invasively after the preparation of the EDML (t0post). DMEK was performed the next day using these grafts. Follow-up examinations took place 6 weeks, 6 months and 1 year postoperatively where the ECD was assessed. In addition, the impact of ECL 1 (during preparation) and ECL 2 (during surgery) on the ECD, visual acuity (VA) and pachymetry at 6 months and 1 year was investigated. RESULTS The average ECD (in cells/mm²) at time points t0pre, t0post, 6 weeks, 6 months & 1 year was 2584 ± 200, 2355 ± 207, 1366 ± 345, 1091 ± 564 and 939 ± 352. The average logMAR VA and pachymetry (in µm) was 0.50 ± 0.27 and 597 ± 63, 0.23 ± 0.17 and 535 ± 54, 0.16 ± 0.12 and 535 ± 54, 0.06 ± 0.08 and 512 ± 37, respectively The ECL 1 (9% on average) had no significant impact on the main outcome measures after 6 months and 1 year (p > 0.11). The ECL 2 correlated significantly with the ECD and the pachymetry at 1 year postop (p < 0.02). CONCLUSION Our results indicate that the non-invasive ECD measurement of the prestripped EDML roll before its transplantation is feasible. Despite significantly decreasing ECD up to 6 months postoperatively, visual acuity further improved and thickness further decreased up to 1 year postoperatively.
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Affiliation(s)
- Kolja Berg
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany.
| | - Tarek Safi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
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Storp JJ, Lahme L, Al-Nawaiseh S, Eter N, Alnawaiseh M. Descemet Membrane Endothelial Keratoplasty (DMEK) Reduces the Corneal Epithelial Thickness in Fuchs' Patients. J Clin Med 2023; 12:jcm12103573. [PMID: 37240679 DOI: 10.3390/jcm12103573] [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: 04/19/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Fuchs' endothelial corneal dystrophy (FECD) is the occurrence of corneal edema due to endothelial cell dystrophy. Descemet membrane endothelial keratoplasty (DMEK) is considered to be the gold standard of treatment. The aim of this study was to investigate the changes in the corneal epithelial thickness of FECD patients before and after DMEK and to compare these results with a healthy control cohort. In this retrospective analysis, 38 eyes of patients with FECD that were treated with DMEK and 35 healthy control eyes received anterior segment optical coherence tomography (OCT; Optovue, XR-Avanti, Fremont, CA, USA). The corneal epithelial thicknesses in different locations were analyzed and compared between the preoperative, postoperative, and control cohorts. The median follow-up time was 9 months. There was a significant degression of the mean epithelial thickness after DMEK in the central, paracentral, and mid-peripheral zones (p < 0.01) of the cornea. The total corneal thickness and stromal thickness decreased significantly as well. No significant differences were observed between the postoperative and control cohorts. In conclusion, the FECD patients had an increased epithelial thickness compared to the healthy controls, which decreased significantly after DMEK and reached thickness levels comparable to those of healthy control eyes. This study emphasized the importance of distinguishing between the corneal layers in anterior segment pathologies and surgical procedures. Moreover, it accentuated the fact that the structural alterations in FECD extend beyond the corneal stroma.
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Affiliation(s)
- Jens Julian Storp
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Larissa Lahme
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Sami Al-Nawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology, Klinikum Bielefeld gem. GmbH, 33604 Bielefeld, Germany
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Maffre C, Fournié P, Durbant E, Arndt C, Djerada Z, Denoyer A. Identifying predictive factors for long-term visual recovery after corneal endothelial keratoplasty in Fuchs' dystrophy: Potential interaction between the corneal dysfunction and retinal status. Front Med (Lausanne) 2023; 10:1120283. [PMID: 36968840 PMCID: PMC10034073 DOI: 10.3389/fmed.2023.1120283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
IntroductionDescemet membrane endothelial keratoplasty (DMEK) is the main treatment for Fuchs' dystrophy (FECD). The outcomes are excellent, but the final visual recovery may vary from patient to patient with sometimes no obvious reason of such a spread.MethodsWe conducted a clinical prospective multicentric study to identify the predictive factors for the visual result 1 year after surgery. Eighty three patients (83 eyes) were included.ResultsPostoperative BCVA after 1 year was 0.20 ± 0.18 logMAR. Logistic regression revealed that good visual recovery correlated negatively with preoperative central macular thickness (p < 0.001) and the need for rebubbling (p = 0.05), and positively with preoperative visual acuity (p = 0.009). Multivariate formula to predict the 1-year BCVA has been suggested.DiscussionPreoperative retinal status seems to be the main predictive factor for long-term visual result after DMEK. Our predictive multivariate model could assist in better informing the patient about the prognosis of the surgery, and in adjusting the therapeutic strategy also, further highlighting the essential collaboration between both cornea and retina subspecialists.
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Affiliation(s)
- Charlotte Maffre
- University of Reims Champagne-Ardenne, Reims, France
- University Hospital Robert Debré, Reims, France
| | - Pierre Fournié
- University of Toulouse III Paul Sabatier, Toulouse, France
| | - Eve Durbant
- University Hospital Robert Debré, Reims, France
| | - Carl Arndt
- University of Reims Champagne-Ardenne, Reims, France
- University Hospital Robert Debré, Reims, France
| | - Zoubir Djerada
- University of Reims Champagne-Ardenne, Reims, France
- University Hospital Robert Debré, Reims, France
| | - Alexandre Denoyer
- University of Reims Champagne-Ardenne, Reims, France
- University Hospital Robert Debré, Reims, France
- CARDIOVIR Research Team, EA-4684, University of Reims Champagne-Ardenne, Reims, France
- *Correspondence: Alexandre Denoyer
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Çakmak S, Kirgiz A, Yildirim Y, Taşkoparan S, Genç S, Ağca A. The effect of anterior segment parameters on surgical success of Descemet membrane endothelial keratoplasty: a prospective study. Int Ophthalmol 2023; 43:197-205. [PMID: 35810243 DOI: 10.1007/s10792-022-02416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate how anterior segment parameters affect the success of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial insufficiency without stromal opacities and to identify factors predisposing them to repeat keratoplasty. METHODS Our prospective observational study included patients who underwent primary DMEK for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy between March 2019 and March 2020. After a detailed ophthalmologic examination, corneal topographic analysis, anterior segment optical coherence tomography (AS-OCT) scans, endothelial cell density (ECD) and axial length (AL) measurements were performed. Surgical success was defined as no endothelial dysfunction during follow-up. Changes in the parameters and how preoperative parameters affect surgical success were investigated. RESULTS In 43 eyes of 43 patients (mean age: 68.58 ± 8.51 years), mean visual acuity was 1.73 ± 0.74 LogMAR before DMEK and 0.31 ± 0.29 LogMAR in the final visit. Central corneal thickness (CCT, p = 0.026) and mean anterior chamber depth (ACD, p = 0.001) affected surgical success. Preoperative CCT values greater than 770 µm increased the risk of repeat keratoplasty by 8.75-fold, whereas preoperative ACD values less than 2.5 mm increased the risk by 2.92-fold. CONCLUSION Preoperative higher CCT and lower ACD values were associated with surgical failure after DMEK. Early surgery may be considered for more successful results. TRIAL REGISTRATION This prospective study has been registered on the ClinicalTrials.gov system with the registration number NCT04420429 on 06/06/2020.
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Affiliation(s)
- Semih Çakmak
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey.
| | - Ahmet Kirgiz
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Yusuf Yildirim
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
| | - Sariye Taşkoparan
- 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
| | - Alper Ağca
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, 34420, Istanbul, Turkey
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Moskwa R, Bloch F, Vermion JC, Zevering Y, Chaussard D, Nesseler A, Goetz C, Perone JM. Postoperative, but not preoperative, central corneal thickness correlates with the postoperative visual outcomes of Descemet membrane endothelial keratoplasty. PLoS One 2023; 18:e0282594. [PMID: 36867645 PMCID: PMC9983850 DOI: 10.1371/journal.pone.0282594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) restores visual acuity in patients with progressive corneal endothelial diseases such as Fuchs endothelial corneal dystrophy (FECD). However, patients often prefer to delay the surgery as long as possible, even though outcomes are poorer in advanced FECD. A recent study proposed that preoperative central corneal thickness (CCT) of ≥625 μm associated with worse best spectacle-corrected visual acuity (BSCVA) after DMEK for FECD. Since this threshold could signal to both surgeons and patients when to perform DMEK, we further explored the relationship between CCT and BSCVA with a retrospective cohort study. The cohort consisted of all patients with FECD who underwent DMEK in a tertiary-care hospital in 2015-2020 and were followed for 12 months. Extremely decompensated corneas were not included. Relationships between preoperative CCT and BSCVA on days 8 and 15 and months 1, 3, 6, and 12 were examined with Pearson correlation analyses. Eyes with preoperative CCT <625 or ≥625 μm were also compared in terms of postoperative BSCVA. Relationships between postoperative CCT and final BSCVA were also explored. The cohort consisted of 124 first-operated eyes. Preoperative CCT did not correlate with postoperative BSCVA at any timepoint. Eye subgroups did not differ in postoperative BSCVA. However, postoperative CCT at 1-12 months correlated significantly with 12-month BSCVA (r = 0.29-0.49, p = 0.020-0.001). Thus, postoperative, but not preoperative, CCT correlated with postoperative BSCVA. This phenomenon may reflect factors that distort preoperative CCT measurements but disappear after surgery. This observation and our analysis of the literature suggest that while there is a relationship between CCT and post-DMEK visual acuity, preoperative CCT measurements may not always adequately reflect that relationship and may therefore not be a reliable predictor of DMEK visual outcomes.
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Affiliation(s)
- Remi Moskwa
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Florian Bloch
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Yinka Zevering
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Dimitri Chaussard
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Alice Nesseler
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Christophe Goetz
- Research Support Unit, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
- * E-mail:
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Bloch F, Dinot V, Goetz C, Zevering Y, Lhuillier L, Perone JM. Ability of routinely collected clinical factors to predict good visual results after primary Descemet membrane endothelial keratoplasty: a cohort study. BMC Ophthalmol 2022; 22:350. [PMID: 35999622 PMCID: PMC9400293 DOI: 10.1186/s12886-022-02574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 07/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND A comprehensive analysis of routinely collected pre/perioperative demographic/clinical factors that could predict final visual acuity after primary Descemet membrane endothelial keratoplasty (DMEK) has not been conducted previously. METHODS A retrospective monocenter cohort study was performed with consecutive patients with Fuchs endothelial corneal dystrophy (FECD) who underwent DMEK or triple-DMEK (DMEK combined with cataract surgery) in 2016-2020 in a French tertiary-care hospital. DMEK-only patients were pseudophakic. Patients were followed for 12 months. Surgery was considered successful when 12-month best-corrected visual acuity (BCVA) was ≤0.1 logMAR (≥0.8). Exploratory multivariate analysis was conducted with the following routinely collected variables to determine their ability to predict 12-month BCVA: patient age and sex; graft donor age; triple DMEK; preoperative values of BCVA, endothelial cell density (ECD), central corneal thickness (CCT), and mean anterior keratometry; and rebubbling. RESULTS Of 100 eyes (100 patients; mean age, 72 years; 61% female), 81 achieved a 12-month BCVA of ≤0.1 logMAR. Logistic regression analysis showed that older age was a significant prognosticator for 12-month BCVA > 0.1 logMAR (Odds Ratio = 0.914, 95% confidence intervals = 0.846-0.987; p = 0.02). CONCLUSIONS An older age associated with worse visual acuity outcomes after DMEK. This was confirmed by our analysis of the literature and supports the notion that DMEK should be conducted without delay once symptoms appear. Patient sex, donor age, triple-DMEK, and anterior keratometry also did not predict final BCVA in the literature. Preoperative CCT, ECD, and BCVA, and rebubbling occasionally appear in the literature as BCVA predictors, possibly reflecting an underlying ECD-BCVA axis.
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Affiliation(s)
- Florian Bloch
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, 1 Allée du Château, CS 45001, 57085, Metz-Cedex 03, France
| | - Vincent Dinot
- Clinical Research Support Unit, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Christophe Goetz
- Clinical Research Support Unit, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France
| | - Yinka Zevering
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, 1 Allée du Château, CS 45001, 57085, Metz-Cedex 03, France
| | - Louis Lhuillier
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, 1 Allée du Château, CS 45001, 57085, Metz-Cedex 03, France
| | - Jean-Marc Perone
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, Mercy Hospital, 1 Allée du Château, CS 45001, 57085, Metz-Cedex 03, France.
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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.
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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,
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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.
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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:
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Hsueh YJ, Chen YN, Tsao YT, Cheng CM, Wu WC, Chen HC. The Pathomechanism, Antioxidant Biomarkers, and Treatment of Oxidative Stress-Related Eye Diseases. Int J Mol Sci 2022; 23:ijms23031255. [PMID: 35163178 PMCID: PMC8835903 DOI: 10.3390/ijms23031255] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/13/2022] Open
Abstract
Oxidative stress is an important pathomechanism found in numerous ocular degenerative diseases. To provide a better understanding of the mechanism and treatment of oxidant/antioxidant imbalance-induced ocular diseases, this article summarizes and provides updates on the relevant research. We review the oxidative damage (e.g., lipid peroxidation, DNA lesions, autophagy, and apoptosis) that occurs in different areas of the eye (e.g., cornea, anterior chamber, lens, retina, and optic nerve). We then introduce the antioxidant mechanisms present in the eye, as well as the ocular diseases that occur as a result of antioxidant imbalances (e.g., keratoconus, cataracts, age-related macular degeneration, and glaucoma), the relevant antioxidant biomarkers, and the potential of predictive diagnostics. Finally, we discuss natural antioxidant therapies for oxidative stress-related ocular diseases.
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Affiliation(s)
- Yi-Jen Hsueh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (Y.-J.H.); (Y.-N.C.); (Y.-T.T.); (W.-C.W.)
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Yen-Ning Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (Y.-J.H.); (Y.-N.C.); (Y.-T.T.); (W.-C.W.)
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Yu-Ting Tsao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (Y.-J.H.); (Y.-N.C.); (Y.-T.T.); (W.-C.W.)
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30012, Taiwan;
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (Y.-J.H.); (Y.-N.C.); (Y.-T.T.); (W.-C.W.)
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (Y.-J.H.); (Y.-N.C.); (Y.-T.T.); (W.-C.W.)
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 7855); Fax: +886-3-328-7798
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Retinometer predicts visual outcome in Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2022; 260:2283-2290. [PMID: 35218379 PMCID: PMC9203399 DOI: 10.1007/s00417-022-05605-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To analyze the preoperative predictive value of retinometer visual acuity (VA) in eyes following Descemet membrane endothelial keratoplasty (DMEK). METHODS Patients undergoing DMEK between August 2011 and July 2020 were included. Preoperative interference visual acuity was assessed using Heine Lambda 100 Retinometer. Depending on the presence or absence of concomitant ocular disease, the Retinometer was evaluated for its ability to preoperatively predict best-corrected visual acuity (BCVA) six months after surgery using correlation, simple and multiple linear regression, contingency analyses, and receiver operating characteristic (ROC) analysis. Preoperative corneal backscatter was correlated with Retinometer prediction accuracy. RESULTS A total of 198 eyes were included in the analysis. There was a significant correlation between Retinometer VA and postoperative BCVA (r = 0.647, P < 0.001). Regardless of the presence or absence of concomitant ocular disease and the surgery procedure (DMEK & triple DMEK), Retinometer VA was the most significant predictor of postoperative BCVA (P < 0.001). ROC analysis revealed reliable diagnostic performance of the Retinometer (AUC = 0.829, P < 0.001). A Retinometer VA ≥ 0.5 accurately predicted a postoperative BCVA ≥ 0.5 in 91% of cases. No association was found between corneal backscatter and prediction accuracy (P = 0.566). CONCLUSIONS Retinometer VA can be used for preoperative prediction of postoperative BCVA in DMEK and triple DMEK patients, independent of increased backscatter values and the presence or absence of concomitant ocular disease. By using this simple but effective tool, indication for DMEK can be facilitated and postoperative outcomes can be realistically predicted preoperatively.
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Hsueh YJ, Meir YJJ, Lai JY, Huang CC, Lu TT, Ma DHK, Cheng CM, Wu WC, Chen HC. Ascorbic acid ameliorates corneal endothelial dysfunction and enhances cell proliferation via the noncanonical GLUT1-ERK axis. Biomed Pharmacother 2021; 144:112306. [PMID: 34656060 DOI: 10.1016/j.biopha.2021.112306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pumping function of corneal endothelial cells (CECs) plays a pivotal role in the maintenance of corneal water homeostasis. Corneal endothelial dysfunction (CED) leads to corneal edema and opacity, but with the exception of keratoplasty, no optimal therapeutic strategies have been established for CED. In this study, we aimed to investigate the ameliorative effect of ascorbic acid (AA) on CED and the underlying mechanism of action in the corneal endothelium. METHODS Rabbit corneal endothelial damage was induced by anterior chamber injection of benzalkonium chloride (BAK). AA was topically administered to the corneal surface, and the transparency and thickness of the cornea were assessed by external eye photography, slit-lamp photography, and ultrasonic pachymetry. To further analyze the mechanism, rabbit CECs and immortalized human CECs (B4G12 cells) were cultured. A ferric reducing/antioxidant and AA (FRASC) assay was performed to measure the AA concentration. Cell proliferation was evaluated by cell counting and bromodeoxyuridine (BrdU) labeling assays, and protein expression was examined by liquid chromatography-mass spectrometry (LC/MS) and immunoblotting. The involvement of glucose transporter 1 (GLUT1) and phospho-ERK was evaluated via GLUT1-siRNA and phospho-ERK inhibitor (PD98059) treatment. INTERPRETATION We observed that topical AA ameliorates BAK-induced rabbit corneal endothelial damage. Furthermore, we demonstrated that AA is transported into B4G12 cells via GLUT1, and afterward, AA increases ERK phosphorylation and promotes cell proliferation. Our findings indicate that CEC proliferation stimulated via the noncanonical AA-GLUT1-ERK axis contributes to AA-enhanced healing of CED.
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Affiliation(s)
- Yi-Jen Hsueh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Yaa-Jyuhn James Meir
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan.
| | - Jui-Yang Lai
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Materials Engineering, Ming Chi University of Technology, New Taipei City, Taiwan; Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Chieh-Cheng Huang
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
| | - Tsai-Te Lu
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chao-Min Cheng
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Changes in Corneal Parameters after DMEK Surgery: A Swept-Source Imaging Analysis at 12-Month Follow-Up Time. J Ophthalmol 2021; 2021:3055722. [PMID: 34336256 PMCID: PMC8321767 DOI: 10.1155/2021/3055722] [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: 04/26/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the time course changes in corneal topographic parameters during the one-year follow-up after Descemet membrane endothelial keratoplasty (DMEK) surgery. Materials and Methods Twenty-one patients (24 eyes) who underwent DMEK surgery were evaluated. Best corrected visual acuity (BCVA), endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA), and higher-order aberration (HOA) were assessed at baseline and 1, 3, 6 and 12 months after the surgery using CASIA2 anterior segment swept-source OCT (Tomey, Japan). Results In patients who underwent DMEK surgery, BCVA improved gradually at the subsequent visits during the 12-month follow-up. A significant reduction in ECC and CCT at the 1st month was noted, which remained stable until the 6th month postoperatively. Anterior and total MK values remained unchanged, whereas changes in posterior keratometry were noticeable until the 6th month after surgery. A significant reduction in the anterior, posterior, and total astigmatism magnitude as well as astigmatism asymmetry was observed during the first 6 months after surgery. A gradual anterior, posterior, and total HOA decrease was documented until the 12th month after surgery. Negative correlations between baseline values of CCT, MK, MA, AA, and HOA and postoperative variations in those parameters at consecutive follow-up time points were observed. Accordingly, negative correlations between baseline CCT and postoperative changes in corneal topographic parameters after surgery were found. Conclusion The stabilization of most corneal topographic parameters takes place within 6 months after the procedure, whereas HOA reduction and BCVA improvement gradually occur during the first year after surgery. Preoperative values of corneal topographic parameters strongly determine their changes detected after DMEK surgery, which may suggest that early therapeutic intervention results in better visual outcomes.
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Miron A, Sajet A, Groeneveld-van Beek EA, Kok JS, Dedeci M, de Jong M, Amo-Addae V, Melles GRJ, Oellerich S, van der Wees J. Endothelial Cell Viability after DMEK Graft Preparation. Curr Eye Res 2021; 46:1621-1630. [PMID: 34027768 DOI: 10.1080/02713683.2021.1927111] [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: 02/06/2023]
Abstract
Aim: To evaluate the effect of graft preparation and organ-culture storage on endothelial cell density (ECD) and viability of Descemet membrane endothelial keratoplasty (DMEK) grafts.Materials and methods: DMEK grafts (n = 27) were prepared at Amnitrans EyeBank Rotterdam from 27 corneas (15 donors) that were eligible for transplantation but could not be allocated due to the Covid-19-related cancellation of elective surgeries. Cell viability (by Calcein-AM staining) and ECD of five grafts originally scheduled for transplantation were evaluated on the originally planned surgery day, whereas 22 grafts from paired donor corneas were evaluated either directly post-preparation or after 3-7 days of storage. ECD was analyzed by light microscopy (LM ECD) and Calcein-AM staining (Calcein-ECD).Results: Light microscopy (LM) evaluation of all grafts showed an unremarkable endothelial cell monolayer directly after preparation. However, median Calcein-ECD for the five grafts initially allocated for transplantation was 18% (range 92-73%) lower than median LM ECD. For the paired DMEK grafts, Calcein-ECD determined by Calcein-AM staining on the day of graft preparation and after 3-7 days of graft storage showed a median decrease of 1% and 2%, respectively. Median percentage of central graft area populated by viable cells after preparation and after 3-7 days of graft storage was 88% and 92%, respectively.Conclusion: Cell viability of most of the grafts will not be affected by preparation and storage. Endothelial cell damage may be observed for some grafts within hours after preparation, with insignificant additional ECD changes during 3-7 days of graft storage. Implementing an additional post-preparation step in the eye bank to evaluate cell density before graft release for transplantation may help to reduce postoperative DMEK complications.
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Affiliation(s)
- Alina Miron
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
| | - Anita Sajet
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
| | - Esther A Groeneveld-van Beek
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
| | - Jet S Kok
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
| | - Mehtap Dedeci
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
| | - Maloeke de Jong
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
| | - Vicky Amo-Addae
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands.,Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
| | - Jacqueline van der Wees
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.,Amnitrans EyeBank, Rotterdam, The Netherlands
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Tsao Y, Wu W, Chen K, Yeh L, Hwang Y, Hsueh Y, Chen H, Cheng C. Analysis of aqueous humor total antioxidant capacity and its correlation with corneal endothelial health. Bioeng Transl Med 2021; 6:e10199. [PMID: 34027088 PMCID: PMC8126826 DOI: 10.1002/btm2.10199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/11/2020] [Accepted: 10/29/2020] [Indexed: 02/04/2023] Open
Abstract
Corneal endothelial decompensation is a serious condition that frequently requires treatment via corneal transplantation which contributes to a global shortage in donor corneas. Therefore, the purpose of this study was to analyze the influence of aqueous humor total antioxidant capacity (TAC) on corneal endothelial health. There is an urgent need for discovering protective factors to combat corneal endothelial cell (CEC) loss. For methods, we developed a cupric ion-based TAC (CuTAC) assay to analyze TAC level in a small volume of aqueous humor, that is, 10 μL per test, and examined the influences of ascorbic acid (AA) and antioxidant proteins on aqueous humor TAC. To broaden the investigation, we conducted a case-control study with patients classified into two groups, an insufficient endothelial cell density (ECD < 2100 cells/mm2) group, and a control group. These groups were formed based on baseline ECD values and were used to evaluate the influence of aqueous humor TAC and AA on overall corneal endothelial health. A CuTAC assay was used to accurately measure aqueous humor TAC without the need for sample dilution. After analyzing a total of 164 human aqueous humor samples, we found that AA was the major contributor to aqueous humor TAC (73.2%). In addition, TAC and AA levels in the IECD and control groups were both found to be significantly different (1.168 vs. 1.592 mM, p = 0.009 and 0.856 vs. 1.178 mM, p = 0.016). TAC and AA were considered independent protective factors against IECD with adjusted odds ratios of 0.02 (p = 0.017) and 0.023 (p = 0.033), respectively. In conclusion, aqueous humor TAC and AA contribute to the maintenance of sufficient corneal ECD, and our CuTAC assay can be a useful tool for analyzing TAC using only a small aqueous humor sample volume.
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Affiliation(s)
- Yu‐Ting Tsao
- Institute of Biomedical Engineering, National Tsing Hua UniversityHsinchuTaiwan
- Department of EducationChang Gung Memorial HospitalLinkouTaiwan
| | - Wei‐Chi Wu
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
| | - Kuan‐Jen Chen
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
| | - Lung‐Kun Yeh
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
| | - Yih‐Shiou Hwang
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
| | - Yi‐Jen Hsueh
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Center for Tissue EngineeringChang Gung Memorial HospitalLinkouTaiwan
| | - Hung‐Chi Chen
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
- Center for Tissue EngineeringChang Gung Memorial HospitalLinkouTaiwan
| | - Chao‐Min Cheng
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua UniversityHsinchuTaiwan
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Okumura N, Koizumi N. Review and perspective of tissue engineering therapy for the treatment of corneal endothelial decompensation. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1811088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
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Dunker SL, Dickman MM, Wisse RPL, Nobacht S, Wijdh RHJ, Bartels MC, Tang ML, van den Biggelaar FJHM, Kruit PJ, Nuijts RMMA. Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty: A Multicenter Randomized Controlled Clinical Trial. Ophthalmology 2020; 127:1152-1159. [PMID: 32386811 DOI: 10.1016/j.ophtha.2020.02.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), refractive astigmatism, and complications after Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). DESIGN Prospective, multicenter randomized controlled trial. PARTICIPANTS Fifty-four pseudophakic eyes of 54 patients with corneal endothelial dysfunction resulting from Fuchs endothelial corneal dystrophy were enrolled in 6 corneal centers in The Netherlands. METHODS Participants were allocated to DMEK (n = 29) or UT-DSAEK (n = 25) using minimization randomization based on preoperative BSCVA, recipient central corneal thickness, gender, age, and institution. Donor corneas were prestripped and precut for DMEK and UT-DSAEK, respectively. Six corneal surgeons participated in this study. MAIN OUTCOME MEASURES The primary outcome measure was BSCVA at 12 months after surgery. RESULTS Central graft thickness of UT-DSAEK lamellae measured 101 μm (95% confidence interval [CI], 90-112 μm). Best spectacle-corrected visual acuity did not differ significantly between DMEK and UT-DSAEK groups at 3 months (0.15 logarithm of the minimum angle of resolution [logMAR] [95% CI 0.08-0.22 logMAR] vs. 0.22 logMAR [95% CI 0.16-0.27 logMAR]; P = 0.15), 6 months (0.11 logMAR [95% CI 0.05-0.17 logMAR] vs. 0.16 logMAR [95% CI 0.12-0.21 logMAR]; P = 0.20), and 12 months (0.08 logMAR [95% CI 0.03-0.14 logMAR] vs. 0.15 logMAR [95% CI 0.10-0.19 logMAR]; P = 0.06). Twelve months after surgery, the percentage of eyes reaching 20/25 Snellen BSCVA was higher in DMEK compared with UT-DSAEK (66% vs. 33%; P = 0.02). Endothelial cell density did not differ significantly 12 months after DMEK and UT-DSAEK (1870 cells/mm2 [95% CI 1670-2069 cells/mm2] vs. 1612 cells/mm2 [95% CI 1326-1898 cells/mm2]; P = 0.12). Both techniques induced a mild hyperopic shift (12 months: +0.22 diopter [D; 95% CI -0.23 to 0.68 D] for DMEK vs. +0.58 D [95% CI 0.13-1.03 D] for UT-DSAEK; P = 0.34). CONCLUSIONS Descemet membrane endothelial keratoplasty and UT-DSAEK did not differ significantly in mean BSCVA, but the percentage of eyes achieving 20/25 Snellen vision was significantly higher with DMEK. Endothelial cell loss did not differ significantly between the treatment groups, and both techniques induced a minimal hyperopic shift.
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Affiliation(s)
- Suryan L Dunker
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert P L Wisse
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Siamak Nobacht
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Robert H J Wijdh
- Department of Ophthalmology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Mei L Tang
- Department of Ophthalmology, Gelre Hospitals, Apeldoorn, The Netherlands
| | | | - Pieter J Kruit
- Euro Tissue Bank - Bio Implant Service (ETB-BISLIFE), Leiden, The Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
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Oellerich S, Ham L, Frank LE, Gorges S, Bourgonje VJ, Baydoun L, van Dijk K, Melles GR. Parameters Associated With Endothelial Cell Density Variability After Descemet Membrane Endothelial Keratoplasty. Am J Ophthalmol 2020; 211:22-30. [PMID: 31647928 DOI: 10.1016/j.ajo.2019.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/25/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate which parameters may affect endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK) by comparing eyes in the low vs high quartile of endothelial cell loss over a follow-up period of 4 years. DESIGN Retrospective cohort study. METHODS Donor endothelial cell density (ECD) decline was evaluated for 351 eyes of 275 patients up to 4 years after DMEK for Fuchs endothelial corneal dystrophy (FECD). Eyes with a postoperative endothelial cell loss in the lower quartile at all available follow-up moments were assigned to Group 1 (n = 51) and those in the upper quartile to Group 2 (n = 42). Multinomial regression was used to assess which covariates were related to greater ECD decline. RESULTS Mean endothelial cell loss as compared to preoperative donor ECD for the entire study group was 33 (±16)%, 36 (±17)%, and 52 (±18)% at 1, 6, and 48 months postoperatively. Endothelial cell loss of Group 1 was 12 (±7)%, 13 (±6)%, and 26 (±8)% at, respectively, 1, 6, and 48 months postoperatively, and 59 (±10)%, 64 (±9)%, and 75 (±5)% in Group 2. Partial graft detachment, donor death cause cardiovascular/stroke (vs cancer), postoperative complications other than graft detachment, and severity of preoperative FECD (all P < .01) showed the strongest relation with greater ECD decline. CONCLUSIONS DMEK eyes with a completely attached graft and operated in an early stage of FECD may show the lowest endothelial cell loss postoperatively.
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Abstract
Penetrating keratoplasty was the only therapeutic choice for the treatment of corneal endothelial decompensation until the introduction of evolutional endothelial keratoplasties, namely Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK). Although now in widespread use, DSAEK and DMEK still have associated problems, such as difficulty of the surgical technique, acute and chronic cell loss, and shortage of donor corneas. Therefore, regeneration of the corneal endothelium by tissue engineering techniques is being researched to overcome these problems. The concept of transplantation of cultured corneal endothelial cells (CECs) was proposed in the 1970s. However, cultivation of human CECs (HCECs) in sufficient quantity and with acceptable quality for clinical use has proven surprisingly difficult, and the development of methods for transplanting cultured HCECs has been necessary. Numerous research groups have developed culture protocols and techniques that are now bringing corneal endothelial regeneration closer to real-world therapy. For instance, we started a clinical trial in 2013 involving the injection of cultured HCECs into the anterior chamber of patients with corneal endothelial decompensation. This review outlines the rapid progression of this research field, including clinical trial results, and is also intended to identify topics that still require further research or discussion.
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Affiliation(s)
- Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
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20
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Patel SV, Lass JH, Benetz BA, Szczotka-Flynn LB, Cohen NJ, Ayala AR, Maguire MG, Drury DC, Dunn SP, Jeng BH, Jones MF, Menegay HJ, Oliva MS, Rosenwasser GOD, Seedor JA, Terry MA, Verdier DD. Postoperative Endothelial Cell Density Is Associated with Late Endothelial Graft Failure after Descemet Stripping Automated Endothelial Keratoplasty. Ophthalmology 2019; 126:1076-1083. [PMID: 30790587 DOI: 10.1016/j.ophtha.2019.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/17/2019] [Accepted: 02/11/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To determine whether preoperative endothelial cell density (ECD) and postoperative ECD after Descemet stripping automated endothelial keratoplasty (DSAEK) are associated with late endothelial graft failure (LEGF) in the Cornea Preservation Time Study (CPTS). DESIGN Cohort study within a multicenter, randomized clinical trial. PARTICIPANTS A total of 1007 individuals (1223 study eyes), mean age 70 years, undergoing DSAEK for Fuchs' dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE) (6% of eyes) and followed for up to 5 years. METHODS Central ECD was determined by a central image analysis reading center. Preoperative ECD was determined for 1209 eyes that did not fail and 14 eyes that experienced LEGF. The ECD at 6 and 12 months after DSAEK, the change in ECD from preoperative to 6 and 12 months, surgeon-reported operative complications, and postoperative graft dislocation were investigated for an association with LEGFs unrelated to other postoperative events. Univariable and multivariable Cox proportional hazards regression models were used to assess associations. MAIN OUTCOME MEASURES Late endothelial graft failure and its associations with pre- and postoperative ECD and operative complications. RESULTS The cumulative probability of LEGF was 1.3% (95% confidence interval [CI], 0.8%-2.4%). Median (interquartile range [IQR]) preoperative ECDs were similar for eyes with LEGF (2523; 2367-3161) cells/mm2) and eyes without failure (2727; 2508-2973) cells/mm2) (P = 0.34). The ECD at 6 months was associated with LEGF (P < 0.001) in time-to-event analyses, whereas preoperative ECD was not (P = 0.55). The cumulative incidence (95% CI) of LEGF was 6.5% (3.0%, 14.0%) for 97 grafts with a 6-month ECD less than 1200 cells/mm2, 0.3% (0.0%, 2.4%) for 310 grafts with a 6-month ECD between 1200 and 2000 cells/mm2, and 0.6% (0.1%, 2.7%) for 589 grafts with a 6-month ECD greater than 2000 cells/mm2. In multivariable analyses, ECD at 6 months and operative complications were both associated with LEGF (P = 0.002 and P = 0.01, respectively), whereas graft dislocation was not (P = 0.61). CONCLUSIONS In eyes undergoing DSAEK, preoperative ECD is unrelated to LEGF, whereas lower ECD at 6 months is associated with LEGF. Early endothelial cell loss after DSAEK and intraoperative complications should be minimized to improve graft survival.
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Affiliation(s)
- Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jonathan H Lass
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio.
| | - Beth Ann Benetz
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio
| | - Loretta B Szczotka-Flynn
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio
| | | | | | - Maureen G Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Steven P Dunn
- Michigan Cornea Consultants, P.C., Southfield, Michigan
| | - Bennie H Jeng
- University of California-San Francisco, San Francisco, California (now the University of Maryland, Baltimore, Maryland)
| | | | - Harry J Menegay
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio
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