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Karaca EE, Işık FD, Özek D, Evren Kemer Ö. Comparison of efficacy of three gases for anterior chamber tamponade in Descemet's membrane endothelial keratoplasty. J Fr Ophtalmol 2024; 47:103979. [PMID: 37858497 DOI: 10.1016/j.jfo.2023.06.010] [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: 04/26/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To compare the efficacy of three different gases for intraocular tamponade: 100% air, 10% perfluoropropane (C3F8), and 10% sulfur hexafluoride (SF6), in Descemet's membrane endothelial keratoplasty (DMEK). MATERIALS AND METHODS The medical records of 138 patients who underwent DMEK were reviewed retrospectively, with the primary outcome being the rebubbling rate in the first week following surgery. Other clinical outcomes, such as best-corrected visual acuity (BCVA), central corneal thickness (CCT), incidence of rebubbling after the first week, endothelial cell density (ECD), graft detachment, graft failure, pupillary block, and intraocular pressure (IOP) changes were also analyzed. RESULTS Of the 138 patients, 57 were in group 1 (treated with air), 44 in group 2 (treated with 10% C3F8), and 37 in group 3 (treated with 10% SF6). Group 3 showed significantly lower rates of graft detachment and rebubbling compared to groups 1 and 2 (P<0.001). However, there was no significant difference in postoperative BCVA among the groups. At one year, the mean endothelial cell loss was 32% in group 1, 30% in group 2, and 33% in group 3 (P=0.715). One patient in group 1 experienced pupillary block and increased IOP, while there were no such occurrences in the other groups. There was no difference between the groups in terms of graft failure. CONCLUSION The use of 10% SF6 in DMEK surgery may be a good option due to its efficacy in preventing graft detachment, low rebubbling rate, and potential for minimizing complications.
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Affiliation(s)
- E E Karaca
- Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - F D Işık
- Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - D Özek
- Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ö Evren Kemer
- Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
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2
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Wiley ZC, Huang X, Staggers KA, Hamill MB. Comparison of 20% SF6 and 6% C3F8 Gas for Anterior Chamber Tamponade in Endothelial Keratoplasty. Cornea 2024:00003226-990000000-00455. [PMID: 38251881 DOI: 10.1097/ico.0000000000003469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The aim of this study was to compare the rates of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) between patients who had anterior chamber (AC) graft tamponade with 20% sulfur hexafluoride gas (SF6) and 6% perfluoropropane gas (C3F8). METHODS The charts of 431 patients undergoing EK from June 8, 2010, to April 16, 2023, were reviewed. Patients undergoing EK alone as well as combined procedures with cataract extraction and intraocular lens implantation were included. Eyes with tube shunts, anterior chamber intraocular lenses, and large peripheral iridotomy with posterior loss of bubble, and patients undergoing cyclophotocoagulation or synechialysis were excluded. All rebubble procedures were performed within 1 month after initial surgery. RESULTS A total of 346 eyes using SF6 and 167 eyes using C3F8 were analyzed. Overall, 46 eyes (9%) required rebubbling; 33 eyes (10%) in the SF6 group and 13 eyes (8%) in the C3F8 group. For those patients undergoing DMEK, the odds of requiring rebubbling in the C3F8 group were about 22% lower than that of patients in the SF6 group (operating room [OR]: 0.782; P < 0.001). For patients undergoing DSEK, however, the gas type did not significantly affect rebubbling rates (P = 0.99). CONCLUSIONS For DMEK, utilization of 6% C3F8 as an AC tamponade was associated with a significantly lower odds of graft rebubbling compared with 20% SF6. Gas type did not result in a significant difference for DSEK. Utilization of 6% C3F8 for graft tamponade could be considered to reduce graft detachment rates in DMEK.
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Affiliation(s)
- Zachary C Wiley
- Baylor College of Medicine, Cullen Eye Institute, Houston, TX; and
| | - Xiaofan Huang
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX
| | - Kristen A Staggers
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX
| | - M Bowes Hamill
- Baylor College of Medicine, Cullen Eye Institute, Houston, TX; and
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3
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Glaucoma in Patients With Endothelial Keratoplasty. Cornea 2022; 41:1584-1599. [DOI: 10.1097/ico.0000000000003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022]
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4
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Singh P, Sinha A, Nagpal R, Chaurasia S. Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 2022; 70:3222-3238. [PMID: 36018091 DOI: 10.4103/ijo.ijo_2933_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is the closest to the physiological replacement of endothelial cells. In the initial years, the technique was surgically challenging. Over the years, with better understanding and modifications in the surgical steps, the technique has evolved as an alternative to more popular procedure Descemet stripping endothelial keratoplasty. The article highlights the various preoperative, intraoperative, and postoperative nuances of DMEK. Additionally, it summarizes the various comparative and noncomparative studies on DMEK outcomes.
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Affiliation(s)
- Prabhakar Singh
- Department of Cornea and Anterior Segment, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Akanksha Sinha
- Cornea and Anterior Segment, Sankara Eye Hospital, Kanpur, Uttar Pradesh, India
| | - Ritu Nagpal
- Research Officer, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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5
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Deshmukh R, Nair S, Ting DSJ, Agarwal T, Beltz J, Vajpayee RB. Graft detachments in endothelial keratoplasty. Br J Ophthalmol 2021; 106:1-13. [PMID: 33397659 DOI: 10.1136/bjophthalmol-2020-318092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022]
Abstract
Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.
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Affiliation(s)
- Rashmi Deshmukh
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sridevi Nair
- Department of Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, India
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tushar Agarwal
- Department of Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, India
| | - Jacqueline Beltz
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Rasik B Vajpayee
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia .,Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Vision Eye Institute Ltd, Melbourne, Victoria, Australia
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Sulfur Hexafluoride 20% Versus Air 100% for Anterior Chamber Tamponade in DMEK: A Meta-Analysis. Cornea 2018; 37:691-697. [DOI: 10.1097/ico.0000000000001581] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Santander-García D, Dapena I, Baydoun L, Melles GRJ. DMEK complications: current treatment and recommendations. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diana Santander-García
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Gerrit R. J. Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans Eye Bank Rotterdam, Rotterdam, The Netherlands
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8
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Air Versus Sulfur Hexafluoride Gas Tamponade in Descemet Membrane Endothelial Keratoplasty: A Fellow Eye Comparison. Cornea 2017; 37:15-19. [DOI: 10.1097/ico.0000000000001413] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Gegúndez-Fernández JA, Fernández-Vigo JI, Díaz-Valle D, Cuiña-Sardiña R, Benítez-Del-Castillo JM. Ciliochoroidal detachment following pure sulfur hexafluoride injection in Descemet stripping automated endothelial keratoplasty. Can J Ophthalmol 2017; 52:e159-e161. [PMID: 28985820 DOI: 10.1016/j.jcjo.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - David Díaz-Valle
- Ophthalmology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Factors Associated With Graft Detachment After Primary Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2017; 36:265-268. [PMID: 28079683 DOI: 10.1097/ico.0000000000001123] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify risk factors associated with postoperative graft detachment after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS In this retrospective institutional cohort study, the study group included all consecutive eyes that underwent primary DSAEK between January 2005 and October 2015 at Villa Serena-Villa Igea private hospitals (Forlì, Italy) and developed postoperative graft detachment (n = 45). The control group included all eyes that underwent primary DSAEK during the same period and did not develop graft detachment (n = 1167). The main outcome measure was whether or not postoperative graft detachment occurred. RESULTS Main indications for surgery included Fuchs endothelial dystrophy (525/1212 = 41%), pseudophakic bullous keratopathy (422/1212 = 35%), and a failed penetrating keratoplasty (PK) graft (190/1212 = 16%). Postoperative graft detachment occurred in 45 of 1212 (3.7%) eyes. Medically treated glaucoma, previous trabeculectomy, previous aqueous shunt procedure, and failed PK were all associated with an increased risk for graft detachment in univariate analysis. No particular lens status at the time of graft implantation was significantly associated with graft detachment, including the presence of an anterior chamber intraocular lens [odds ratio (OR), 1.5; 95% confidence interval (CI), 0.35-6.46, P = 0.58] or aphakia at the time of graft transplantation (OR, 1.37; 95% CI, 0.41-4.57, P = 0.74). Cataract removal during surgery was not associated with an increased risk for detachment (OR, 0.77; 95% CI, 0.39-1.5, P = 0.47). Previous trabeculectomy (OR, 4.21; 95% CI, 1.53-11.56, P = 0.005) and a previous failed PK graft (OR, 3.04; 95% CI, 1.6-5.78, P = 0.001) were the only independent risk factors for graft detachment in multivariate analyses. CONCLUSIONS Previous PK and trabeculectomy are independent risk factors for postoperative graft detachment in primary DSAEK.
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Comparison of 5% Sulfur Hexafluoride Versus 100% Air Tamponade in Descemet Membrane Endothelial Keratoplasty. Cornea 2017; 36:1189-1194. [DOI: 10.1097/ico.0000000000001299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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12
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Pedemonte-Sarrias E, Salvador Playà T, Sassot Cladera I, Gris O, Ribas Martínez J, García-Arumí J, Giménez N. Incidence of cystoid macular edema after Descemet's stripping automated endothelial keratoplasty. Int J Ophthalmol 2017; 10:1081-1087. [PMID: 28730110 DOI: 10.18240/ijo.2017.07.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the incidence of cystoid macular edema (CME) after Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone (7%; 3/41) and the other three, DSAEK combined with phacoemulsification (21%; 3/14). Five out of six patients with CME responded to standard therapy. CONCLUSION CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber (PC) intraocular lens (IOL) implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.
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Affiliation(s)
- Eduard Pedemonte-Sarrias
- Ophthalmology Department, Hospital Universitari MútuaTerrassa, Fundació Docència i Recerca MútuaTerrassa, Universitat de Barcelona, Terrassa 08221, Spain.,Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Health Sciences Research Institute Germans Trias i Pujol Foundation, Badalona 08930, Spain.,Surgery Department, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
| | - Toni Salvador Playà
- Ophthalmology Department, Hospital Universitari MútuaTerrassa, Fundació Docència i Recerca MútuaTerrassa, Universitat de Barcelona, Terrassa 08221, Spain
| | - Irene Sassot Cladera
- Ophthalmology Department, Hospital Universitari MútuaTerrassa, Fundació Docència i Recerca MútuaTerrassa, Universitat de Barcelona, Terrassa 08221, Spain
| | - Oscar Gris
- Surgery Department, Universitat Autònoma de Barcelona, Barcelona 08035, Spain.,Instituto de Microcirugía Ocular (IMO), Barcelona 08035, Spain
| | - Joan Ribas Martínez
- Ophthalmology Department, Hospital Sant Antoni Abat, Vilanova i la Geltrú 08800, Spain
| | - José García-Arumí
- Surgery Department, Universitat Autònoma de Barcelona, Barcelona 08035, Spain.,Instituto de Microcirugía Ocular (IMO), Barcelona 08035, Spain.,Ophthalmology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
| | - Núria Giménez
- Research Unit, Fundació Docència i Recerca MútuaTerrassa, Universitat de Barcelona, Terrassa 08221, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Hesse M, Kuerten D, Walter P, Plange N, Johnen S, Fuest M. The effect of air, SF6 and C3F8 on immortalized human corneal endothelial cells. Acta Ophthalmol 2017; 95:e284-e290. [PMID: 27595913 DOI: 10.1111/aos.13256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/31/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE While anterior chamber air bubbles aid attachment during posterior lamellar surgery only for few days, these periods can be prolonged with gases in non-expanding concentrations. To test the effects of different gas compositions on immortalized human corneal endothelial cells (HCEC-12), we utilized Transwell inserts with semipermeable membranes as an artificial anterior chamber model. METHODS Human corneal endothelial cells (HCEC-12) were cultured on Transwell inserts for 24 hr, then flipped, burdened and sunk with titanium rings in medium (M1), as well as filled with 2 ml of air (A), 20% sulphur hexafluoride (SF6) (S), or 12% C3F8 (C). After gas exposition for 24, 48 and 120 hr, cells were evaluated by live/dead staining, cell viability assay and Ki67 immunohistochemistry. RESULTS Proliferation was significantly reduced (Ki67-positive fraction; M1, 14.8 ± 2.0%; A, 7.9 ± 1.4%; S, 8.1 ± 1.3%; C, 9.9 ± 2.3%; p-values; A, S, C versus M1 < 0.01), the total cell number decreased and the percentage of dead cells increased under gas exposition, independently of the type of gas (120 hr cell count/2.25 cm2 : M1 = 660.8 ± 57.0 cells; A = 125.5 ± 17.4 cells, S = 123.5 ± 17.0 cells, C = 118.8 ± 16.6 cells; p-value: M versus A/S/C < 0.001; 120 hr dead cells: M = 2.6 ± 1.0%, A = 8.4 ± 2.7%, S = 9.5 ± 3.2%, C = 11.3 ± 3.1%; p-value: M1 versus A/S/C < 0.01). Medium (M1)-control also proved significantly higher cell viability values in comparison with the gases, which did not differ significantly among them (120 hr luminescence: M1 = 1752.2 ± 91.4, A = 433.0 ± 30.3, S = 507.8 ± 23.3, C = 523.8 ± 20.3; p-value: M1 versus A/S/C < 0.01). CONCLUSIONS Gas exposition led to a reduction in proliferation and an increase in cell death in HCEC-12, independently of the gas composition.
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Affiliation(s)
- Marina Hesse
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - David Kuerten
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Peter Walter
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Niklas Plange
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Sandra Johnen
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Matthias Fuest
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
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14
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Schaub F, Simons HG, Roters S, Heindl LM, Kugler W, Bachmann BO, Cursiefen C. [Influence of 20 % sulfur hexafluoride (SF6) on human corneal endothelial cells : An in vitro study]. Ophthalmologe 2017; 113:52-7. [PMID: 26025298 DOI: 10.1007/s00347-015-0051-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In posterior lamellar keratoplasties, such as Descemet membrane endothelial keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) an air bubble is left inside the anterior chamber to promote graft attachment during the early postoperative period. In the case of insufficient graft adhesion a renewed intracameral air injection is often necessary. The use of sulfur hexafluoride diluted with air (SF6 20 %) as an alternative to pure air may further enhance graft attachment and reduce the rebubbling rate. The effect of SF6 20 % on corneal endothelium is currently unclear and was therefore examined in vitro. MATERIAL AND METHODS For this study 12 human corneoscleral discs were mounted in artificial anterior chambers, the systems were continuously filled with culture medium and the anterior chambers with air (n = 5) or SF6 20 % (n = 7) as tamponade. After 6 days of storage in the incubator endothelial cell density, toxicity on endothelial cells and corneal thickness were evaluated. RESULTS There were no significant differences in endothelial cell loss (p = 1.000), endothelial cell count (p = 0.648), toxicity on endothelial cells (p = 0.048) and central corneal thickness (p = 0.905) between the two groups after 1 week. The level of significance was defined as p ≤ 0.05 and adjusted to p ≤ 0.0056 according to the Bonferroni correction for multiple testing. CONCLUSION The use of SF6 20 % as tamponade in the anterior chamber for posterior lamellar keratoplasty can be proposed as a safe alternative to pure air filling related to endothelial cell loss. Increased toxic effects on the corneal endothelium by SF6 20 % were not detected in this study; however, further prospective clinical trials are needed to examine the long-term effects in humans.
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Affiliation(s)
- F Schaub
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland.
| | - H G Simons
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - S Roters
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - W Kugler
- Gesellschaft für hochreine Biomaterialien, FLUORON GmbH, Ulm, Deutschland
| | - B O Bachmann
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland
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15
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Schaub F, Enders P, Snijders K, Schrittenlocher S, Siebelmann S, Heindl LM, Bachmann BO, Cursiefen C. One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF6) 20% versus 100% air for anterior chamber tamponade. Br J Ophthalmol 2016; 101:902-908. [DOI: 10.1136/bjophthalmol-2016-309653] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/15/2016] [Accepted: 10/21/2016] [Indexed: 02/05/2023]
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16
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Impact of Introducing 2 Simple Technique Modifications on the Descemet Membrane Endothelial Keratoplasty Learning Curve. Eur J Ophthalmol 2016; 27:16-20. [DOI: 10.5301/ejo.5000808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose To analyze the impact of performing premarking of the Descemet roll and using SF6 20% on a surgeon's Descemet membrane endothelial keratoplasty (DMEK) learning process. Methods A total of 30 consecutive eyes with endothelial dysfunction undergoing DMEK during the learning curve of a surgeon were retrospectively analyzed. Prior to the study, the surgeon had already performed 10 DMEKs. The first 15 consecutive patients were included in group 1 (no premarking and air tamponade) and the other 15 consecutive patients were included in group 2 (premarking and SF6 tamponade). Main outcome parameters were best-corrected visual acuity (BCVA), endothelial cell density (ECD) loss at 6 months, and intraoperative and postoperative complications. Results Among the 2 groups, BCVA and ECD loss at 6 months were similar. However, there was a statistically significant reduction in primary graft failure (40% vs 0%) and need of rebubbling due to complete or partial graft detachment (40% vs 6%) when comparing group 1 versus group 2. In group 1, half of the patients needing rebubbling had primary graft failure. Conclusions Based on our personal experience, premarking the graft to assess orientation and using a SF6 gas tamponade dramatically reduces the risk of primary graft failure and the need for rebubbling even during the first stages of the learning curve. These findings should encourage surgeons to safely change from Descemet stripping automated endothelial keratoplasty to DMEK.
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Güell JL, Morral M, Gris O, Elies D, Manero F. Comparison of Sulfur Hexafluoride 20% versus Air Tamponade in Descemet Membrane Endothelial Keratoplasty. Ophthalmology 2015; 122:1757-64. [DOI: 10.1016/j.ophtha.2015.05.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 11/25/2022] Open
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