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Schrittenlocher S, Weliwitage J, Matthaei M, Bachmann B, Cursiefen C. Influence of Donor Factors on Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Preparation Outcome. Clin Ophthalmol 2024; 18:793-797. [PMID: 38495675 PMCID: PMC10941787 DOI: 10.2147/opth.s448912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery. Patients and Methods Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors' previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting. Results Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p<0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009). Several cardiovascular diseases (p-values between <0.001 and p=0.038), DMel type II, chronic kidney disease and previous cataract-surgery were associated with peripheral adherences (p=0.004; p=0.020 and p<0.001 respectively). Furthermore, pseudophakic donor eyes presented a higher degree of fragility of the graft (p<0.001). Age was a significant risk factor for difficult preparation (p<0.001). The staining of the graft was poorer in donors with chronic kidney disease (p=0.037). Conclusion Donor diabetes mellitus type 2, heart failure, previous cataract surgery, chronic kidney disease and age are associated with a difficult DMEK graft preparation. For every one-year increment in donor age, the odds of having very difficult preparation were increased by 3%. Also, chronic kidney disease predisposes to a poor tissue staining with trypan blue during preparation.
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Affiliation(s)
- Silvia Schrittenlocher
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
| | - Jithmi Weliwitage
- University of Cologne, Institute for Medical Statistics and Computational Biology (IMSB), Cologne, NRW, Germany
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
| | - Björn Bachmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
- University of Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, NRW, Germany
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Dua HS, Freitas R, Mohammed I, Ting DSJ, Said DG. The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy. Prog Retin Eye Res 2023; 97:101161. [PMID: 36642673 DOI: 10.1016/j.preteyeres.2022.101161] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 μm (range 6-16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700 mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals. The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK. The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.
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Affiliation(s)
- Harminder S Dua
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Rui Freitas
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal.
| | - Imran Mohammed
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Darren S J Ting
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Dalia G Said
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK; Research Institute of Ophthalmology, Cairo, Egypt.
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Dua HS, Freitas R, Sadek Y, Ting DSJ, Nubile M, Mohammed I, Said DG. An approach to reduce Descemet's membrane scrolling: Relevance to Descemet's membrane endothelial keratoplasty (DMEK). Indian J Ophthalmol 2023; 71:3178-3185. [PMID: 37602605 PMCID: PMC10565912 DOI: 10.4103/ijo.ijo_1531_23] [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: 06/11/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose We aimed to determine whether Descemet's membrane (DM) scrolling occurs primarily along the vertical or horizontal axis and establish whether oval trephination along the axis of least scrolling can reduce the grade of the scroll. Methods The longest limbus-to-limbus axis on 28 sclerocorneal discs was taken as the horizontal axis. The horizontal (n = 7) or (right angles to it) vertical (n = 6) axis was marked on DM before peeling it off. The direction and grade of scrolling was observed. Narrow strips (3-4 mm wide) were then cut along the two axes (n = 4 each) and the scrolling pattern was observed. Ellipses (7 × 9 mm) of DM were punched along the two axes (n = 6 each) and the scrolls graded. Immunofluorescent staining for elastin on horizontal and vertical tissue sections from three DM samples was performed. The intensity and thickness of elastin staining were measured. Results Twenty-four (85.72%) DM samples showed scrolling along the horizontal axis, none showed scrolling along the vertical axis, and four (14.28%) samples showed a spiral scroll, regardless of which axis was marked (grade 3.7 and 3.6). Vertically oval discs showed significantly reduced scrolling (grade 1.2) compared to horizontally oval discs (grade 3.5). Narrow strips of DM showed a similar scrolling pattern. Immunohistology showed no difference in any of the parameters examined along the two axes or from the center to the periphery. Conclusion DM scrolls primarily along the horizontal axis. Vertically oval DM samples show minimal scrolling, which can be an advantage in DMEK. Differential scrolling is not determined by the distribution of elastin.
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Affiliation(s)
- Harminder S Dua
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
| | - Rui Freitas
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
- Department of Ophthalmology, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal
| | - Youssef Sadek
- Department of Medicine, University of Birmingham, Birmingham Research Park, Birmingham, UK
| | - Darren SJ Ting
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
| | - Mario Nubile
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. d’Annunzio of Chieti-Pescara, Italy
| | - Imran Mohammed
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
| | - Dalia G Said
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
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Schrittenlocher S, Matthaei M, Rokohl AC, Franklin J, Bachmann B, Cursiefen C. Influence of Descemet Membrane Endothelial Keratoplasty Graft Preparation Patterns on Postoperative Clinical Outcome. Cornea 2023; 42:940-945. [PMID: 36730372 DOI: 10.1097/ico.0000000000003141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to quantify preparation difficulties and complications during DMEK graft preparation and their influence on clinical outcome. METHODS A retrospective evaluation of 214 consecutive DMEK surgeries from the prospective Cologne DMEK database was performed between July 2018 and December 2019. Preparation conditions (such as central and peripheral adherences, tissue fragility, and Descemet membrane splitting) were quantified and divided into 3 groups: easy, difficult, and very difficult preparation. At follow-up (3, 6, and 12 months after DMEK), best spectacle-corrected visual acuity, endothelial cell count (ECC), and rebubbling rates were evaluated and compared between groups. RESULTS An easy preparation was possible in 41.6% of cases (group 1, n = 89), a difficult preparation of the DMEK graft occurred in 30.8% (group 2, n = 66), and a very difficult preparation occurred in 27.6% (group 3, n = 59). There was no difference between groups for best spectacle-corrected visual acuity at 3, 6, and 12 months ( P = 0.179, P = 0.325, and P = 0.682, respectively) or for ECC at 3 and 6 months ( P = 0.537 and P = 0.606, respectively). Only at 12 months, the ECC was slightly significant between groups ( P = 0.045). Regarding the rebubbling rate, there was no difference ( P = 0.585). 17.9% of eyes from group 1, 25.7% of eyes from group 2, and 23.7% of eyes from group 3 received at least 1 rebubbling. CONCLUSIONS These data suggest that difficult preparation conditions do not lead to any worsening of visual acuity or rebubbling rate in the 1-year outcome after DMEK. The endothelial cell density at 12 months showed slightly poorer results in the cases of very difficult preparation.
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Affiliation(s)
| | - Mario Matthaei
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Alexander C Rokohl
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Jeremy Franklin
- Institute for Medical Statistics and Computational Biology (IMSB), University of Cologne, Germany; and
| | - Björn Bachmann
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Claus Cursiefen
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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Effect of Collagenase A on Descemet Membrane Endothelial Keratoplasty Scroll Tightness. Cornea 2022; 41:1029-1034. [PMID: 35830580 DOI: 10.1097/ico.0000000000003030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The scrolling properties of the Descemet membrane endothelial keratoplasty (DMEK) graft are essential for surgical success. Currently, there is limited knowledge on what dictates the tightness of the DMEK scroll. The purpose of this study was to determine the impact of temperature and protein digestion on DMEK graft scroll tightness. METHODS For the temperature experiment, a total of 28 eyes were used for this study. Scrolls in the cold group were kept at 4°C while scrolls in the hot group were kept at 37°C. Scroll width was recorded at the 5-, 15-, and 30-minute mark. For the protein digestion experiment, a total of 18 eyes were exposed to collagenase A (10 CDU/mL) in Optisol solution. Scroll width was recorded at the time points of 1, 3, 5, 10, and 20 minutes. RESULTS The results of the temperature experiment did not yield any statistically significant changes in the mean scroll width of the DMEK scrolls across both temperature ranges and observation times. For the protein digestion experiment, the mean scroll width grew from 1.85 mm to 2.13 mm from the beginning of the experiment until the final observation at 20 minutes. This is a 14.7% change over 20 minutes with a P value (<0.001), exemplifying a statistically significant change in scroll width. CONCLUSIONS Temperature did not have any significant effect over scroll tightness, but scroll tightness decreased with collagenase exposure.
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AlShaker SM, Humphreys C, Smigielski N, Chan CC. The Effect of COVID-19 on Corneal Donor Volumes and Eye Bank Processes: An Analysis From the Eye Bank of Canada (Ontario Division). Cornea 2022; 41:757-765. [PMID: 35184122 DOI: 10.1097/ico.0000000000003004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE With the rise in COVID-19 cases, the Eye Bank of Canada (Ontario Division), the largest eye bank in Canada, was faced with challenges related to ocular donor suitability which resulted in tissue shortages after the first wave of COVID-19 cases in Ontario, Canada. This article aims to analyze the impact of COVID-19 on ocular tissue donation and transplant surgeries. METHODS Trends in ocular donations in 2020 and the transplant rates were compared with the data from the previous year, as a benchmark of normal eye bank activity. RESULTS Ocular donor volumes decreased during the first wave of the COVID-19 pandemic (March-June 2020) by 65% as compared to the same period in 2019. By the end of the year 2020, this had resulted in a total reduction of 29% of ocular donor volumes as compared to 2019. The ocular transplant surgery volumes in the year 2020 decreased by 32% compared to the previous year, mostly secondary to elective surgery shutdown during the first wave. Because of tissue shortages, the Eye Bank of Canada (Ontario Division) had to import 24 corneas from the United States and cancel 7 surgeries in the year 2020. CONCLUSIONS The decline in ocular tissue donor volumes and transplant surgery was a result of an interplay of causes related to the COVID-19 pandemic. Most importantly, ruling out of COVID-19 carriers, lockdown measures affecting tissue retrieval processes, and shutdown of elective surgery were the 3 major factors accounting for tissue shortages and surgical volume reductions.
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Affiliation(s)
- Sara M AlShaker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Clara C Chan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Eye Bank of Canada Ontario Division, Toronto, Ontario, Canada; and
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The Cologne-Mecklenburg-Vorpommern DMEK Donor Study (COMEDOS) - design and review of the influence of donor characteristics on Descemet membrane endothelial keratoplasty (DMEK) outcome. Graefes Arch Clin Exp Ophthalmol 2022; 260:2417-2426. [PMID: 35294636 PMCID: PMC9325796 DOI: 10.1007/s00417-022-05594-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: 08/24/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Posterior lamellar keratoplasty and especially Descemet membrane endothelial keratoplasty (DMEK) are gaining interest worldwide. Little is known about the influence of donor factors on DMEK outcome. Here we provide an overview of the existing peer-reviewed literature on this topic and present the design of the upcoming cooperation study COMEDOS (Cologne-Mecklenburg-Vorpommern DMEK Donor Study). Methods A literature search of PubMed and MEDLINE was conducted to retrieve articles published between September 2013 and May 2021. Seventeen peer-reviewed articles were selected. Design and concept of the prospective COMEDOS are outlined. Results Main interest parameters were the donor diabetes mellitus status, age, and lens status. There is a large heterogeneity regarding the sample size, study design, and investigated parameters. There seems to be a consensus that younger donors are associated with tighter rolls, a more difficult preparation, and unfolding setting. Diabetic donors seem to increase the risk of tissue tearing due to adherences and result more frequently in preparation failure. The COMEDOS aims not only to analyze the diabetes status of the donor, but also to correlate all donor systemic comorbidities and their ophthalmologic history to the DMEK clinical outcome. Furthermore, a correlation of Descemet membrane lamella preparation and surgery outcome is planned. Conclusion Currently, there is a lack of knowledge regarding the effect and impact of donor tissue characteristics on DMEK outcome and complications. An in-depth investigation is planned by the upcoming COMEDOS to close this knowledge gap.![]()
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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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Hussien AMRM, Elmassry A, Ghaith AA, Goweida MBB. Descemet's Membrane Endothelial Keratoplasty and Phacoemulsification: Combined versus Sequential Surgery. J Curr Ophthalmol 2021; 33:277-284. [PMID: 34765815 PMCID: PMC8579805 DOI: 10.4103/joco.joco_188_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To compare the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) combined with phacoemulsification versus DMEK following phacoemulsification. Methods: In this interventional retrospective comparative nonrandomized case series study, patients with Fuchs endothelial corneal dystrophy (FECD) with either cataract or previous cataract surgery with intraocular lens (IOL) implantation were assigned to one of the two groups according to lens status. Group 1 included patients who had cataract and FECD and would undergo triple procedure (phacoemulsification with IOL implantation and DMEK), whereas Group 2 included patients who had FECD and had phacoemulsification with IOL implantation earlier and would undergo DMEK only as a sequential procedure. Results: Postoperative best corrected visual acuity (BCVA) in both groups at 1 week, 1 month, 3 months, and 6 months revealed a statistically nonsignificant difference between the two groups with mean logMAR BCVA at 6 months of 0.07 ± 0.18 and 0.07 ± 0.19 in Group 1 and Group 2, respectively (P > 0.05). The drop in endothelial cell density by the end of the 6th postoperative month was by 39.44% ±7.92 and 38.73% ±8.10 in the triple-procedure group and DMEK only group, respectively (P = 0.005). Total postoperative complications rate and the rebubbling rate were statistically similar between both groups with 13.5% and 12.5% rebubbling rate in Group 1 and Group 2, respectively (P > 0.05). Conclusion: Visual outcomes, endothelial cell loss, and rebubbling rate are comparable when DMEK is combined with phacoemulsification or when it is performed as staged procedure, without statistically significant difference in the outcomes.
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Affiliation(s)
- Ahmed Mahmoud Ragab Mahmoud Hussien
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Department of Ophthalmology, Torbay and South Devon NHS Trust, Torquay, UK
| | - Ahmed Elmassry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Alaa Atef Ghaith
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Smeringaiova I, Paaske Utheim T, Jirsova K. Ex vivo expansion and characterization of human corneal endothelium for transplantation: a review. Stem Cell Res Ther 2021; 12:554. [PMID: 34717745 PMCID: PMC8556978 DOI: 10.1186/s13287-021-02611-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022] Open
Abstract
The corneal endothelium plays a key role in maintaining corneal transparency. Its dysfunction is currently treated with penetrating or lamellar keratoplasty. Advanced cell therapy methods seek to address the persistent global deficiency of donor corneas by enabling the renewal of the endothelial monolayer with tissue-engineered grafts. This review provides an overview of recently published literature on the preparation of endothelial grafts for transplantation derived from cadaveric corneas that have developed over the last decade (2010–2021). Factors such as the most suitable donor parameters, culture substrates and media, endothelial graft storage conditions, and transplantation methods are discussed. Despite efforts to utilize alternative cellular sources, such as induced pluripotent cells, cadaveric corneas appear to be the best source of cells for graft preparation to date. However, native endothelial cells have a limited natural proliferative capacity, and they often undergo rapid phenotype changes in ex vivo culture. This is the main reason why no culture protocol for a clinical-grade endothelial graft prepared from cadaveric corneas has been standardized so far. Currently, the most established ex vivo culture protocol involves the peel-and-digest method of cell isolation and cell culture by the dual media method, including the repeated alternation of high and low mitogenic conditions. Culture media are enriched by additional substances, such as signaling pathway (Rho-associated protein kinase, TGF-β, etc.) inhibitors, to stimulate proliferation and inhibit unwanted morphological changes, particularly the endothelial-to-mesenchymal transition. To date, this promising approach has led to the development of endothelial grafts for the first in-human clinical trial in Japan. In addition to the lack of a standard culture protocol, endothelial-specific markers are still missing to confirm the endothelial phenotype in a graft ready for clinical use. Because the corneal endothelium appears to comprise phenotypically heterogeneous populations of cells, the genomic and proteomic expression of recently proposed endothelial-specific markers, such as Cadherin-2, CD166, or SLC4A11, must be confirmed by additional studies. The preparation of endothelial grafts is still challenging today, but advances in tissue engineering and surgery over the past decade hold promise for the successful treatment of endothelial dysfunctions in more patients worldwide.
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Affiliation(s)
- Ingrida Smeringaiova
- Laboratory of the Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Albertov 4, 128 00, Prague, Czech Republic
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Katerina Jirsova
- Laboratory of the Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Albertov 4, 128 00, Prague, Czech Republic.
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11
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Luke W, Tamme GH, Yee Chen J, Richard M. Corneal Donor Characteristics and Descemet Membrane Endothelial Keratoplasty Success: A Scoping Review. Cornea 2021; 40:930-935. [PMID: 33591040 DOI: 10.1097/ico.0000000000002682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to review published data on donor characteristics and the influence on preoperative Descemet membrane endothelial keratoplasty (DMEK) preparation and intraoperative graft manipulation. METHODS A systematic review of PubMed, EMBASE, OVID MEDLINE, and EBSCOhost was conducted up to April 2020. Studies were screened and predefined data criteria extracted. Eleven studies were found to meet the inclusion criteria. RESULTS Research regarding donor characteristics and the relationship to DMEK graft preparation and intraoperative graft manipulation was found to be limited because of the overall low-quality data. However, there was a trend of evidence supporting donor diabetes increasing the risk of graft tearing and consequent preparation failure and younger donors producing tighter scrolls complicating intraoperative graft unfolding. CONCLUSIONS Further research into the area is warranted to better understand how donor characteristics impact preoperative DMEK graft preparation and intraoperative graft manipulation.
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Affiliation(s)
- Weinel Luke
- Department of Surgical and Perioperative Medicine, Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia
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Parekh M, Ferrari S, Pagano L, Angi M, Gadhvi KA, Romano V. Confounding factors influencing the scroll width of Descemet membrane endothelial keratoplasty graft. Indian J Ophthalmol 2021; 69:461-462. [PMID: 33463617 PMCID: PMC7933887 DOI: 10.4103/ijo.ijo_2642_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mohit Parekh
- Institute of Ophthalmology, University College London, London, UK
| | - Stefano Ferrari
- Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Luca Pagano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Martina Angi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
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Ong HS, Ang M, Mehta J. Evolution of therapies for the corneal endothelium: past, present and future approaches. Br J Ophthalmol 2021; 105:454-467. [PMID: 32709756 PMCID: PMC8005807 DOI: 10.1136/bjophthalmol-2020-316149] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Indexed: 12/13/2022]
Abstract
Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues - regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Marcus Ang
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Jodhbir Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
- School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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Perdikakis G, Fili S, Vastardis I, Kohlhaas M. The correct graft orientation during descemet membrane endothelial keratoplasty (DMEK) using the "bubble-tap" technique. Int Ophthalmol 2021; 41:2329-2337. [PMID: 33730315 DOI: 10.1007/s10792-021-01786-1] [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] [Received: 11/27/2020] [Accepted: 03/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To demonstrate a novel, alternative endothelium Descemet membrane layer (EDM) orientation method in Descemet membrane endothelial keratoplasty (DMEK) that does not involve prior ink or trepanation marking of the graft, or intraoperative ocular coherence tomography (OCT) guided graft implantation during surgery, thus preventing the occurrence of an upside-down graft implantation that leads with certainty to primary graft failure. METHODS From 2017 to early 2020, 500 eyes underwent DMEK operation using the "bubble-tap" technique first described from Dr. Perdikakis in the department of ophthalmology of St.-Johannes- Hospital in Dortmund in Germany. Primary graft failure and re-bubbling results following "bubble-tap" assisted DMEK are presented. RESULTS Primary graft failure due to upside-down graft implantation was not observed in any patient. Re-bubbling was performed in 4.8% of the eyes. In 1.8% of the cases, a re-DMEK was performed due to a graft failure. CONCLUSION The "bubble-tap" technique is a novel, reliable and easy to master orientation method of EDM that enables the surgeon to perform DMEK with safety even in complicated cases with poor visibility in the anterior chamber, while it yields superior or equal results in comparison to other graft marking methods or intraoperative OCT-guided graft implantation.
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Affiliation(s)
- Georgios Perdikakis
- Clinic of Ophthalmology, St. Johannes Hospital, Johannesstrasse 9-17, 44137, Dortmund, Germany.
| | - Sofia Fili
- Clinic of Ophthalmology, St. Johannes Hospital, Johannesstrasse 9-17, 44137, Dortmund, Germany
| | | | - Markus Kohlhaas
- Clinic of Ophthalmology, St. Johannes Hospital, Johannesstrasse 9-17, 44137, Dortmund, Germany
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Pereira NC, Forseto ADS, Maluf RCP, Dua HS. Pre-Descemet's endothelial keratoplasty: a simple, Descemet's membrane scoring technique for successful graft preparation. Br J Ophthalmol 2021; 106:786-789. [PMID: 33597193 DOI: 10.1136/bjophthalmol-2020-317613] [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] [Received: 07/29/2020] [Revised: 12/04/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Pre-Descemet's endothelial keratoplasty (PDEK) donor tissue preparation involves the intrastromal injection of air to create a type 1 big bubble (BB) and avoidance of the creation of a type 2 BB. The purpose of this study was to design and test a technique to consistently creates a type 1 BB without risk of creating a type 2 BB. METHODS A prospective matched study with 64 human donor sclerocorneal discs, which were not suitable for corneal transplantation, was conducted. The corneas were divided into two groups, of which 32 were subjected to the standard technique of preparing the PDEK donor tissue (group 1, control) and 32 new technique, where in the donor Descemet's membrane was scored with a Sinskey hook. Frequency of occurrence of different types of BB was compared and statistically analysed. RESULTS With the standard technique (group 1), type 1 BB occurred in 53.1%, type 2 BB in 34.4% and mixed BB in 12.5% of samples. With the scoring technique (group 2), a type 1 BB occurred in 100% of the samples. No type 2 or mixed BB occurred in any case in group 2. The difference in creation of a type 1BB between the two groups was statistically significant (p=0.00). CONCLUSION The scoring technique is a simple, inexpensive and reproducible option to consistently achieve a type 1 BB to prepare PDEK graft tissue. The next step would be to study the clinical outcomes of PDEK performed with tissue obtained by the scoring technique.
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Affiliation(s)
- Nicolas Cesario Pereira
- Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, São Paulo, Brazil .,Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Adriana Dos Santos Forseto
- Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, São Paulo, Brazil.,Eye Clinic, São Paulo, São Paulo, Brazil
| | | | - Harminder Singh Dua
- Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
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Eccentrically Punched Descemet Membrane Endothelial Keratoplasty Grafts Expand the Descemet Membrane Endothelial Keratoplasty Donor Pool: One Eye Bank's Reappraisal of the Central Clear Zone Convention. Cornea 2020; 39:1252-1255. [DOI: 10.1097/ico.0000000000002348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fukuoka H, Sella R, L Haynie M, Afshari NA. Adhesion Strength and Rolling Properties of Descemet Membrane Endothelial Keratoplasty Grafts in a Rabbit Eye Model. Curr Eye Res 2019; 44:929-933. [PMID: 30965016 DOI: 10.1080/02713683.2019.1606251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate the optimal time for Descemet membrane endothelial keratoplasty (DMEK) graft peeling, and to analyze the rolling properties of endothelial denuded grafts in a rabbit eye model. Materials and Methods: The vertical peeling force required to peel 1 mm wide Descemet membrane (DM) strips, was measured as the change in weight of the system during force application in a rabbit model. Twenty-one rabbit corneoscleral rims were stored in phosphate-buffered saline (PBS) at 4°C, and force analysis was performed at days 1, 5, or 21 after harvesting. After half of the strips of day 5 corneas were peeled and analyzed, the rims were moved to Optisol GS at 4°C, and the remaining strips were peeled off for force analysis at day 10. Separate DM grafts (n = 7) were analyzed by intraoperative optical coherence tomography (OCT) to determine the tissue rolling diameter before and after removal of endothelial cells by a swab. Unpaired t-test was used for statistical analysis. Results: There was a decrease in DM peeling force (p = .008) between days 1 and 5 (556.04 ± 111.76 and 324.30 ± 96.4 mg, respectively), and no difference between days 5 and 21 (p = .53). Peeling force for day 5 corneas placed in Optisol was higher at day 10 (324.30 ± 96.4 to 669.92 ± 166.24 mg, p = .005). The average rolling diameter of DM grafts was similar before and after the removal of endothelial cells (257.9 ± 131.1 and 249.8 ± 126.6 μm, respectively). Conclusions: DMEK Graft procurement could be potentially facilitated by lower DM-stromal adhesion strength at day five after obtaining corneoscleral rims, in a rabbit eye model. Time in the storage medium may influence adhesion strength. Endothelial cells do not appear to play a significant role in the rolling diameter of DM grafts.
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Affiliation(s)
- Hideki Fukuoka
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego , La Jolla , CA , USA
| | - Ruti Sella
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego , La Jolla , CA , USA
| | - Matthew L Haynie
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego , La Jolla , CA , USA
| | - Natalie A Afshari
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego , La Jolla , CA , USA
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Abstract
Lamellar keratoplasty (LK) has revolutionized corneal graft surgery in several ways. Deep anterior LK (DALK) has eliminated risk of failure due to endothelial rejection. Endothelial keratoplasty (EK) has almost eliminated induced astigmatism and the “weak” graft–host junction as seen with penetrating keratoplasty (PK) and also reduced the risk of endothelial rejection. LK provided new insights into posterior corneal anatomy that led to better understanding and performance of DALK and to the development of another EK procedure, namely pre-Descemet's EK (PDEK). Surgical procedures for LK were further refined based on the improved understanding and are able to deliver better surgical outcomes in terms of structural integrity and long-term patient satisfaction, reducing the need of further surgeries and minimizing patient discomfort. In most specialist centers, anterior lamellar techniques like DALK and EK techniques like Descemet's stripping EK (DSEK) and Descemet's membrane EK (DMEK) have replaced the full-thickness PK where possible. The introduction of microkeratome, femtosecond laser, and PDEK clamp have made LK techniques easier and more predictable and have led to the innovation of another LK procedure, namely Bowman membrane transplant (BMT). In this article, we discuss the evolution of different surgical techniques, their principles, main outcomes, and limitations. To date, experience with BMT is limited, but DALK has become the gold standard for anterior LK. The EK procedures too have undergone a rapid transition from DSEK to DMEK and PDEK emerging as a viable option. Ultrathin-DSEK may still have a role in modern EK.
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Affiliation(s)
- Nadisha P Singh
- Division of Clinical Neuroscience, University of Nottingham, UK
| | - Dalia G Said
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Division of Clinical Neuroscience, University of Nottingham, UK
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Novel Technique for Improving Graft Unfolding in Vitrectomized Eyes Using a Temporary Diaphragm in Descemet Membrane Endothelial Keratoplasty. Cornea 2018; 37:1334-1336. [DOI: 10.1097/ico.0000000000001614] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Endothelium-in Versus Endothelium-out Insertion With Descemet Membrane Endothelial Keratoplasty. Cornea 2018; 37:1098-1101. [DOI: 10.1097/ico.0000000000001650] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu Y, Zhang J, Zhang Y, Yin M, Miao S, Liang Q, Pan Z. The feasibility and efficacy of preparing porcine Descemet’s membrane endothelial keratoplasty (DMEK) grafts by two techniques: An ex-vivo investigation for future xeno-DMEK. Xenotransplantation 2018; 25:e12407. [PMID: 29756410 DOI: 10.1111/xen.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/14/2018] [Accepted: 04/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Yang Liu
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; The First Hospital of Lanzhou University; Chengguan District, Lanzhou China
| | - Jing Zhang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Yingnan Zhang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Mingyang Yin
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Sen Miao
- Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Qingfeng Liang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Zhiqiang Pan
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
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[Visual outcomes after Descemet's membrane endothelial keratoplasty]. J Fr Ophtalmol 2017; 40:467-476. [PMID: 28579219 DOI: 10.1016/j.jfo.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Evaluation and monitoring at 6 months after Descemet's membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial dystrophy and study of factors influencing visual rehabilitation and postoperative quality of life. METHODS Prospective, consecutive, interventional study of 35 eyes of 32 patients with Fuchs endothelial dystrophy who underwent surgery from February 2015 to February 2016 by DMEK. Measurement at D10, M1, M3, M6 of visual acuity, graft endothelial cell density, pachymetry, and intraocular pressure, and performance at M6 of aberrometry, macular OCT and a quality of life survey (NEI-VFQ-25). Post-DMEK aberrations are compared to those from control patients selected for refractive surgery. RESULTS Visual acuity improvement at 6 months was statistically significant (P<0.0001), as well as pachymetry decrease (P<0.0001), endothelial cell loss (P<0.0001) and intraocular pressure increase (P=0.003). We observed a statistically significant difference between post-DMEK aberrations and those of control subjects for all aberrations from 2nd to 5th order. There were no postoperative correlations between visual acuity, pachymetry, intraocular pressure, or endothelial cell loss. The global quality of life score at six months was 87, corresponding to a good quality of life. We did not find a link between the global NEI-VFQ-25 score and visual acuity or visual aberrations. Ninety percent of patients surveyed reported a postoperative general improvement in quality of life at M6. CONCLUSION DMEK provides good visual rehabilitation and an improvement in quality of life for patients with Fuchs endothelial dystrophy. Higher order optical aberrations in these patients, although higher than in a healthy population, are negligible and have no impact on quality of vision or postoperative quality of life.
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Dua HS, Termote K, Kenawy MB, Said DG, Jayaswal R, Nubile M, Mastropasqua L, Holland S. Scrolling Characteristics of Pre-Descemet Endothelial Keratoplasty Tissue: An Ex Vivo Study. Am J Ophthalmol 2016; 166:84-90. [PMID: 27038891 DOI: 10.1016/j.ajo.2016.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the scrolling propensity of pre-Descemet endothelial keratoplasty (PDEK) tissue and to compare it with each component of the PDEK tissue, namely the pre-Descemet layer (Dua's layer [PDL]) and the Descemet membrane (DM). DESIGN Experimental laboratory investigation. METHODS Fourteen human donor sclerocorneal discs in which a type 1 big bubble was obtained by stromal injection of air were studied. The wall of the type 1 big bubble was excised and its grade of scrolling noted. The components of the wall (ie, the DM and PDL) were then separated and the scrolling of each was individually graded. Statistical comparison of the grade of scrolling of each layer and correlation with age was carried out; 25-μm slices of anterior and posterior stroma obtained with the femtosecond laser from 4 control samples were used for comparison. The main outcome measure was the grade of scrolling of PDEK tissue in comparison with PDL and DM. RESULTS Mean donor age was 67 years. The mean grade of the scroll formed by PDEK tissue was1.6 compared to 0.64 for PDL alone and 3.6 for DM alone. The difference was statistically significant. No correlation between donor age and degree of scrolling for any of the tissues tested was found. CONCLUSION PDEK tissue scrolls less than DM. PDL scrolls the least. This demonstrates that PDL tissue splints the DM and reduces its scrolling in PDEK. This feature has relevance to tissue preparation, handling, and unscrolling in the eye during endothelial keratoplasty.
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Yin J, Veldman PB. Endothelial Keratoplasty: Descemet's Stripping Automated Endothelial Keratoplasty Versus Descemet's Membrane Endothelial Keratoplasty. Int Ophthalmol Clin 2016; 56:167-183. [PMID: 27257730 DOI: 10.1097/iio.0000000000000118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Veldman PB, Dye PK, Holiman JD, Mayko ZM, Sáles CS, Straiko MD, Galloway JD, Terry MA. The S-stamp in Descemet Membrane Endothelial Keratoplasty Safely Eliminates Upside-down Graft Implantation. Ophthalmology 2016; 123:161-4. [DOI: 10.1016/j.ophtha.2015.08.044] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/28/2015] [Accepted: 08/28/2015] [Indexed: 11/25/2022] Open
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