1
|
Ballesteros-Sánchez A, Peraza-Nieves J, Casablanca-Piñera A, Rodríguez-Calvo-De-Mora M, Catalán-Coronado S, Torras-Sanvicens J, Borroni D, Sánchez-González JM, Rocha-De-Lossada C. Scheimpflug Corneal Densitometry Patterns at the Graft-Host Interface in DMEK and DSAEK: A 12-Month Longitudinal Comparative Study. J Clin Med 2023; 12:7133. [PMID: 38002744 PMCID: PMC10672394 DOI: 10.3390/jcm12227133] [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: 09/29/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND To compare corneal densitometry (CD) patterns at the graft-host interface between Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Corneal densitometry is a quantitative assessment that objectively evaluates corneal clarity and optical quality by measuring the light backscatter from the cornea. METHODS Fifty-one eyes that received DMEK or DSAEK surgery for corneal endothelium dysfunction were evaluated. The primary endpoint included CD patterns at the graft-host interface, which were assessed by the Pentacam HR device at the center point of the corneal horizontal meridian (CDcentral), and at six points on the central circumference of the cornea (with a total diameter of 4 mm) (CDI,II,III,IV,V,VI). Secondary endpoints included the best-corrected distance visual acuity (BCDVA), central corneal thickness (CCT), and graft thickness (GT). All of the evaluations were performed at follow-up appointments one, three, six and twelve months after the procedure. RESULTS DMEK showed a significant overall CD reduction of -7.9 ± 8.5 grayscale unit (GSU) compared to DSAEK (p < 0.001). In addition, the DMEK group showed significantly lower CDCentral,I,II,III,IV,V,VI values at follow-up appointments one, three, six and twelve months after the procedure compared to the DSAEK group (p < 0.001). BCDVA, CCT and GT were in favor of the DMEK group with a mean value of 0.39 ± 0.35 LogMar, 552.2 ± 71.1 µm and 11.03 ± 1.4 µm, respectively (p < 0.001). CONCLUSIONS CD patterns at the graft-host interface seem to be different depending on the endothelial keratoplasty procedure. This provides specific insight into CD changes in this critical region of surgery, which may provide a better understanding of the postoperative evolution of these patients.
Collapse
Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41004 Seville, Spain
- Department of Ophthalmology, Novovision Ophthalmologic Clinic, 30008 Murcia, Spain
| | - Jorge Peraza-Nieves
- Anterior Segment Department, Institut Clinic D’Oftalmologia, Hospital Clinic Barcelona, 08036 Barcelona, Spain; (J.P.-N.); (A.C.-P.); (S.C.-C.); (J.T.-S.)
- Department of Ophthalmology, Castellar Clinic, 08017 Barcelona, Spain
| | - Anna Casablanca-Piñera
- Anterior Segment Department, Institut Clinic D’Oftalmologia, Hospital Clinic Barcelona, 08036 Barcelona, Spain; (J.P.-N.); (A.C.-P.); (S.C.-C.); (J.T.-S.)
| | - Marina Rodríguez-Calvo-De-Mora
- Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120 Almeria, Spain; (M.R.-C.-D.-M.); (C.R.-D.-L.)
- Ophthalmology Department, VITHAS Malaga, 29016 Malaga, Spain
- Department of Ophthalmology, Hospital Regional Universitario, 29011 Malaga, Spain
| | - Saray Catalán-Coronado
- Anterior Segment Department, Institut Clinic D’Oftalmologia, Hospital Clinic Barcelona, 08036 Barcelona, Spain; (J.P.-N.); (A.C.-P.); (S.C.-C.); (J.T.-S.)
| | - Josep Torras-Sanvicens
- Anterior Segment Department, Institut Clinic D’Oftalmologia, Hospital Clinic Barcelona, 08036 Barcelona, Spain; (J.P.-N.); (A.C.-P.); (S.C.-C.); (J.T.-S.)
- School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia;
- Advalia Vision, Cornea Research Unit, 20145 Milan, Italy
| | | | - Carlos Rocha-De-Lossada
- Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120 Almeria, Spain; (M.R.-C.-D.-M.); (C.R.-D.-L.)
- Ophthalmology Department, VITHAS Malaga, 29016 Malaga, Spain
- Department of Ophthalmology, Hospital Regional Universitario, 29011 Malaga, Spain
- Department of Surgery, Ophthalmology Area, University of Seville, 41009 Seville, Spain
| |
Collapse
|
2
|
Sunouchi C, Hayashi T, Shimizu T, Hara Y, Kurita J, Kobashigawa H, Oyakawa I, Ida Y, Kobayashi A, Shoji J, Yamagami S. A Comparison of the Corneal Thickness Following Descemet's Stripping Automated Endothelial Keratoplasty and Descemet's Membrane Endothelial Keratoplasty. Curr Eye Res 2023; 48:712-718. [PMID: 37052462 DOI: 10.1080/02713683.2023.2203424] [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: 01/13/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To compare the central corneal thickness before and after Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK), and to evaluate the recipient corneal thickness following DSAEK. METHODS The corneal thickness was compared between two groups of eyes following DMEK and DSAEK, performed by a single surgeon between 2015 and 2017. We evaluated the recipient corneal thickness and central corneal thickness pre- and postoperatively at 1, 3, and 6 months using anterior segment optical coherence tomography. Recipient corneal thickness was defined as the corneal thickness without graft thickness. RESULTS We included DMEK and DSAEK eyes (n = 26 each), which were similar in terms of their etiologies. Preoperatively, there was no significant difference in the central corneal thickness between the groups (DSAEK, median [interquartile range]: 721 [606.5 to 847.8] µm; and DMEK: 690 [618 to 722.3] µm; p = 0.30). Despite the tendency of the central corneal thickness to be significantly greater (p < .01) at 6 months following DSAEK (619.5 [607.8 to 661.3] µm) compared with that following DMEK (497.5 [475.8 to 525.3] µm), there was no significant difference at 6 months between the recipient corneal thickness following DSAEK (488.5 [443.8 to 515] µm) and central corneal thickness following DMEK (p = 0.54). CONCLUSIONS DSAEK eyes display a similar tendency of stromal thinning as DMEK eyes.
Collapse
Affiliation(s)
- Chihiro Sunouchi
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
| | - Takahiko Hayashi
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Toshiki Shimizu
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
| | - Yusuke Hara
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
| | - Junki Kurita
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
| | | | - Itaru Oyakawa
- Department of Ophthalmology, Heart Life Hospital, Okinawa, Japan
| | - Yasutsugu Ida
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Akira Kobayashi
- Department of Ophthalmology, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Jun Shoji
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
- Shoji Eye Clinic, Chiba, Japan
| | - Satoru Yamagami
- Department of Ophthalmology, Nihon University of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Maier AKB, Milek J, Joussen AM, Dietrich-Ntoukas T, Lichtner G. Systematic Review and Meta-analysis: Outcomes After Descemet Membrane Endothelial Keratoplasty Versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty. Am J Ophthalmol 2023; 245:222-232. [PMID: 36220351 DOI: 10.1016/j.ajo.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the efficacy and safety of ultrathin Descemet stripping (automated) endothelial keratoplasty (UT-DS(A)EK) versus Descemet membrane endothelial keratoplasty (DMEK) for the treatment of Fuchs endothelial dystrophy (FED) and bullous keratopathy (BK). DESIGN Systematic review and meta-analysis. METHODS Literature containing DMEK and UT-DSAEK were searched in the Cochrane Database of Systematic Reviews, PubMed, EMBASE, LILACS, and through manual reference searching. Studies were included that measured the outcome of interventions-including best corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative complications, especially graft detachment with the need of re-bubbling, graft rejection, graft failure, and postoperative elevated intraocular pressure (IOP)-in patients with FED and BK. Included outcomes were pooled as standardized mean differences (SMD) or risk ratios (RR) using random effects models. Inter-study heterogeneity was assessed using the Q-test and I2 statistic. RESULTS Seven (of 163) studies met all the inclusion and exclusion criteria. Meta-analysis showed a significantly better BCVA 12 months postoperatively, but an increased re-bubbling rate in eyes after DMEK compared with eyes after UT-DS(A)EK (BCVA: SMD = 0.50 [95% CI 0.27-0.74] and re-bubbling rate: RR = 0.33 [95% CI 0.16-0.67]). All other parameters did not differ significantly between both interventions, although estimates were imprecise (graft failure: RR = 0.65 [95% CI 0.18-2.30], graft rejection: RR = 1.40 [95% CI 0.27-7.30], and postoperative intraocular pressure elevation: RR = 1.14 [95% CI 0.60-2.18]). Postoperative SMDs of ECD could not be evaluated due to significant heterogeneity between studies. CONCLUSIONS Although the improvement in BCVA was higher after UT-DS(A)EK than after conventional DS(A)EK, the BCVA after DMEK was still superior. The complication rates were comparable for both procedures, except for the higher rate of re-bubbling after DMEK.
Collapse
Affiliation(s)
- Anna-Karina B Maier
- From Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Ophthalmology, Berlin, Germany (A-K.B.M, J.M., A.M.J., T.D-N.).
| | - Jonas Milek
- From Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Ophthalmology, Berlin, Germany (A-K.B.M, J.M., A.M.J., T.D-N.)
| | - Antonia M Joussen
- From Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Ophthalmology, Berlin, Germany (A-K.B.M, J.M., A.M.J., T.D-N.)
| | - Tina Dietrich-Ntoukas
- From Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Ophthalmology, Berlin, Germany (A-K.B.M, J.M., A.M.J., T.D-N.)
| | - Gregor Lichtner
- Universitätsmedizin Greifswald, Department of Anesthesia, Critical Care, Emergency and Pain Medicine, Greifswald, Germany (G.L.)
| |
Collapse
|
4
|
Arora R, Gupta P, Sahu J, Jain P, Vishwanath S, Shroff R. Analysis of Corneal Scheimpflug Densitometry and Ocular Wavefront Aberrations Post Descemet Stripping Automated Endothelial Keratoplasty. Eye Contact Lens 2022; 48:242-249. [PMID: 34860724 DOI: 10.1097/icl.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the role of corneal densitometry and wavefront aberrations post Descemet stripping automated endothelial keratoplasty (DSAEK) and their correlation with visual acuity. METHODS Twenty-seven eyes of 25 patients with nonresolving corneal edema for more than 3 months as a result of Fuchs endothelial corneal dystrophy, pseudophakic bullous keratopathy, or secondary endothelial dysfunction were enrolled in a prospective interventional study and underwent DSAEK. Postoperative evaluation for corneal aberrations, including Higher order aberrations (HOAs) and corneal densitometry (CD), was performed using anterior-segment optical coherence tomography (Avanti RTvue XR; Optovue) and Scheimpflug imaging (Pentacam, Oculus Optikgeräte GmbH, Wetzlar, Germany) at 6 months. A correlation analysis of corneal aberrations, including HOAs and CD, with postoperative best-corrected visual acuity at 6 months was performed. RESULTS Mean best-corrected visual acuity (BCVA) improved from 1.67±0.53 log of minimum angle of resolution (logMAR) to 0.2±0.22 logMAR post DSAEK at 6 months (P≤0.0001). At 6 months, mean root-mean-square (RMS) total corneal aberrations (includes HOA and low-order aberration [LOA]), RMS total HOA, and RMS LOA of the central 6-mm zone were 4.99±2.64, 1.80±0.9, and 4.55±2.64, respectively. The mean corneal densitometry from anterior, central, and posterior zones were 39.12±12.77, 23.9±7.2, and 13.54±2.04 gray scale units, respectively. Total anterior aberrations (r=0.051; P=0.006), anterior LOA (r=0.049; P=0.009), total corneal aberrations (r=0.051; P=0.001), total HOAs (r=0.095; P=0.057) and LOAs (r=0.050; P=0.002), and total CD from 0 to 2 mm (r=0.010; P=0.038) and 2 to 6 mm (r=0.014; P=0.018) showed a significant inverse correlation with postoperative BCVA. CONCLUSION There was an inverse relationship between post DSAEK BCVA and total corneal HOAs and full-thickness densitometry at 6 months. Scheimpflug imaging with added tools for corneal aberration and densitometry analysis gives further insight into the suboptimal vision achieved despite transparent corneas post DSAEK.
Collapse
Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre) (R.A., P.G., J.S., P.J., S.V.), Maulana Azad Medical College, New Delhi, India; and Cornea and Refractive Services (R.S.), Shroff Eye Centre, New Delhi, India
| | | | | | | | | | | |
Collapse
|
5
|
Efficacy of Thin and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Influence of Graft Thickness on Postoperative Outcomes: Systematic Review and Meta-analysis. Am J Ophthalmol 2022; 240:170-186. [PMID: 35346623 DOI: 10.1016/j.ajo.2022.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the efficacy of thin and ultrathin Descemet stripping automated endothelial keratoplasty (T-DSAEK and UT-DSAEK, with graft thickness <130 and <100 µm, respectively), depending on graft thickness. DESIGN Systematic review and meta-analysis. METHOD PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and ScienceDirect databases were searched until October 1, 2021. We computed random-effect meta-analysis on postoperative outcomes of T/UT-DSAEK, stratified by graft thickness (<80 μm, 80-100 μm, and 100-130 μm). The main postoperative outcome was visual acuity (logarithm of the minimum angle of resolution [logMAR]). Secondary outcomes were pachymetry (μm), endothelial cell count (cell/mm2), spherical equivalent (diopter [D]), rebubbling rate (%), and rejection rate (%). Meta-regressions compared postoperative outcomes depending on graft thickness and search for putative confusion factors. RESULTS We included 47 articles for a total of 2141 eyes of 2040 patients. T/UT-DSAEK globally improved visual acuity (effect size = -0.38 logMAR [95% confidence interval {CI} -0.46 to -0.30 logMAR]), without difference depending on graft thickness. Overall, pachymetry improved (-60.6 µm [95% CI -101 to -19.7 µm]), endothelial cell count decreased (-1039 cells/mm2 [95% CI -1209 to -868 cells/mm2), spherical equivalent resulted in a hyperopic shift (0.74 D [95% CI -0.50 to 1.97 D), the graft rejection rate was 0.2% (95% CI -0.1% to 0.4%), and the rebubbling rate was 8.7% (95% CI 6.8%-10.5%). Grafts >100 μm induced a hyperopic shift. Metaregressions did not demonstrate differences between the 3 groups (<80 μm, 80-100 μm, or 100-130 μm) in any outcomes. CONCLUSION All T/UT-DSAEK thickness groups provided similar visual acuity, pachymetry, endothelial cell count, rejection rate, and rebubbling rate regardless of graft thickness. A hyperopic shift was induced by grafts >100 μm.
Collapse
|
6
|
Chaussard D, Bloch F, Elnar AA, Zevering Y, Vermion JC, Moskwa R, Perone JM. Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study. PLoS One 2022; 17:e0264401. [PMID: 35202443 PMCID: PMC8870504 DOI: 10.1371/journal.pone.0264401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015–2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding.
Collapse
Affiliation(s)
- Dimitri Chaussard
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Florian Bloch
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Arpiné Ardzivian Elnar
- Clinical Research Support Unit, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville Regional Hospital Center, Metz, France
| | - Yinka Zevering
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Rémi Moskwa
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
- Institut Jean Lamour, Lorraine University, Nancy, France
- * E-mail:
| |
Collapse
|
7
|
Lang SJ, Heinzelmann S, Böhringer D, Reinhard T, Maier P. Indications for intraoperative anterior segment optical coherence tomography in corneal surgery. Int Ophthalmol 2020; 40:2617-2625. [PMID: 32506295 PMCID: PMC7502442 DOI: 10.1007/s10792-020-01442-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Recently, intraoperative optical coherence tomography (iOCT) has evolved in the field of ophthalmic surgery. So far, the use of iOCT was mainly focused to lamellar keratoplasty, especially deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). The aim of this study was to report our experiences with iOCT to introduce new possibilities of this application. METHODS We used iOCT in 18 patients who underwent the following surgeries: DALK, DMEK, penetrating keratoplasty, autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens, pannus removal on corneal surface and newborn investigation in Peters' anomaly. We obtained qualitative video data for all procedures. RESULTS With the iOCT, the cannula placement during DALK preparation of the recipient cornea and bubble formation could be visualized to improve the success rate of the big bubble injection. In DMEK, the iOCT enables the visualization of Descemet's membrane removal in the recipient and graft orientation as well as better control of graft attachment. The iOCT enables intraoperative visualization of the graft-host interface during penetrating keratoplasty. During autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens and removal of corneal surface pannus the iOCT is capable of showing the thickness of lamellar preparations to avoid penetrations and to save healthy recipient's tissue. CONCLUSION The iOCT is a helpful device for intraoperative anterior segment imaging not only for DALK and DMEK. It is also beneficial in penetrating keratoplasty and every other form of lamellar preparation during corneoscleral surgery.
Collapse
Affiliation(s)
- Stefan J Lang
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Sonja Heinzelmann
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Philip Maier
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| |
Collapse
|
8
|
Lin SR, Prapaipanich P, Yu F, Law SK, Caprioli J, Aldave AJ, Deng SX. Comparison of Endothelial Keratoplasty Techniques in Patients With Prior Glaucoma Surgery: A Case-Matched Study. Am J Ophthalmol 2019; 206:94-101. [PMID: 30935848 DOI: 10.1016/j.ajo.2019.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with those of Descemet's stripping endothelial keratoplasty (DSEK) in eyes with prior glaucoma surgery. DESIGN Case-matched retrospective comparative case series. METHODS Setting/study population: 46 DMEK procedures were matched with 46 DSEK procedures at a single institution. OBSERVATION PROCEDURES cases were matched based on preoperative visual acuity, lens status, and surgical indication. MAIN OUTCOME MEASUREMENTS the outcome measurements included visual acuity improvement, primary and secondary graft failure, endothelial rejection, intraocular pressure (IOP) elevation, and the need for additional glaucoma intervention. RESULTS Best-corrected visual acuity (BCVA) improved by -0.89 logMAR in the DMEK group and -0.62 logMAR in the DSEK group (P = 0.005) at 1 year follow-up. Visual acuity was significantly better in the DMEK group at postoperative months 1, 3, and 12 and at last follow-up. The percentage of patients achieving 20/40 or better best-corrected visual acuity was higher in the DMEK group at all time points, notably 47% in the DMEK group versus 15% in the DSEK group at 1 year (P = 0.002). Secondary graft failure was lower in the DMEK group (DMEK 0% vs. DSEK 17%; P = 0.006). Primary graft failure rates and rebubling rates were similar. There were no differences in the rates of postoperative IOP elevation or in the need for additional glaucoma intervention. CONCLUSIONS In complex eyes with prior glaucoma surgery, DMEK offers faster visual recovery, better final visual acuity, and a lower rate of secondary graft failure compared to DSEK during the first postoperative year and beyond.
Collapse
|
9
|
Densitometry Analysis of Corneal Backscatter After Pre-Descemet Endothelial Keratoplasty for Pseudophakic Bullous Keratopathy. Cornea 2019; 39:30-38. [DOI: 10.1097/ico.0000000000002140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Khakshour H, Nikandish M, Salehi M, Ghooshkhanehei H, Vejdani A. Evaluation of interface reflectivity and corneal aberrations following Descemet's stripping automated endothelial keratoplasty. Oman J Ophthalmol 2019; 12:108-113. [PMID: 31198297 PMCID: PMC6561048 DOI: 10.4103/ojo.ojo_188_2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: This study aims to evaluate visual outcome after Descemet's membrane stripping automated endothelial keratoplasty (DSAEK) and relate to interface and corneal higher-order aberrations (HOAs). MATERIALS AND METHODS: We enrolled 16 eyes of 16 patients (eight males and eight females) in this interventional case series and followed DSAEK operation for about two to 20 months. OCULUS Pentacam, as well as other ophthalmic evaluations in follow-up visits, examined interface reflectivity and HOAs. Statistical relations were analyzed. RESULTS: There was statistically significant correlation between interface reflectivity and best corrected visual acuity (BCVA) (r = 0.56, P = 0.021). Pachymetry (central corneal thickness) and BCVA had a moderate correlation (r = 0.6, P = 0.013). There was no statistically significant correlation between pachymetry and follow-up time (r = −0.36, P = 0.16). Negative correlation between follow-up and interface reflectivity was also not statistically significant (r = −0.24, P = 0.35). Coma had a significant correlation with BCVA in cornea and cornea front maps (r = 0.74, P = 0.009 and r = 0.71, P = 0.013, respectively). CONCLUSION: Significant correlation between interface reflectivity and BSCVA was found, and anterior corneal HOAs are significantly higher than posterior HOAs.
Collapse
Affiliation(s)
- Hamid Khakshour
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Nikandish
- Department of Ophthalmology, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Salehi
- Research Center for Patient Safety, Clinical Research Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Haleh Ghooshkhanehei
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhosein Vejdani
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
11
|
Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2018; 256:1669-1677. [DOI: 10.1007/s00417-018-3997-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/19/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022] Open
|
12
|
Factors Limiting the Visual Outcome After Descemet Stripping Automated Endothelial Keratoplasty: Comprehensive Analysis Including the Graft Position and Irregularity. Cornea 2018; 37:20-27. [PMID: 29040117 DOI: 10.1097/ico.0000000000001424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate factors affecting best postoperative corrected distance visual acuity (CDVA) in patients who have undergone Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS Forty-two eyes of 42 patients with predominantly non-Fuchs endothelial corneal dystrophy after DSAEK were retrospectively evaluated. All patients were examined using anterior segment optical coherence tomography when their best postoperative CDVA had been achieved. We analyzed the relationship between best postoperative CDVA and preoperative, intraoperative, and postoperative factors, including corneal higher-order aberrations (HOAs), corneal backward scattering, graft irregularity, and graft decentration. Variables with P < 0.2 in univariate analysis were entered into a multivariate linear regression model to determine the factors affecting best postoperative CDVA. RESULTS Mean CDVA improved from 1.16 ± 0.46 preoperatively to 0.22 ± 0.19 logarithm of the minimum angle of resolution equivalents postoperatively (P < 0.0001). Best postoperative CDVA was achieved 11.6 ± 7.7 months after DSAEK. Multivariate analysis showed that anterior corneal coma-like HOAs and venting incisions inside the pupil area were significantly correlated with best postoperative CDVA (t = 2.90, P = 0.006; t = 2.62, P = 0.01, respectively). No significant relationship was found between the visual outcome and any other factor, including posterior corneal HOAs, corneal backward scattering, graft decentration, and graft irregularity. CONCLUSIONS Irregularity of the anterior corneal surface and venting incisions inside the pupil area are important factors that impair best postoperative CDVA in patients who have undergone DSAEK. In contrast, our results indicate that the graft position and irregularity might not have a strong influence on the visual outcome after DSAEK.
Collapse
|
13
|
Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF, Weikert MP, Shtein RM. Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology 2017; 125:295-310. [PMID: 28923499 DOI: 10.1016/j.ophtha.2017.08.015] [Citation(s) in RCA: 282] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction. METHODS Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment. RESULTS After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%-47%) at 6 months. Overall change in spherical equivalent was +0.43 diopters (D; range, -1.17 to +1.2 D), with minimal induced astigmatism of +0.03 D (range, -0.03 to +1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%-76%). Intraocular pressure elevation was the second most common complication (range, 0%-22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%-12.5%), secondary graft failure (mean, 2.2%; range, 0%-6.3%), and immune rejection (mean, 1.9%; range, 0%-5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet's stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%-82%), endothelial rejection (mean, 10%; range, 0%-45%), and primary graft failure (mean, 5%; range, 0%-29%). Mean EC loss after DSEK was 37% at 6 months. CONCLUSIONS The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK.
Collapse
Affiliation(s)
- Sophie X Deng
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - W Barry Lee
- Piedmont Hospital and Eye Consultants of Atlanta, Atlanta, Georgia
| | | | - Anthony N Kuo
- Duke Eye Center, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Y Li
- UC Davis Eye Center, University of California, Davis, Sacramento, California
| | | | | | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
14
|
Schaub F, Enders P, Bluhm C, Bachmann BO, Cursiefen C, Heindl LM. Two-Year Course of Corneal Densitometry After Descemet Membrane Endothelial Keratoplasty. Am J Ophthalmol 2017; 175:60-67. [PMID: 27986425 DOI: 10.1016/j.ajo.2016.11.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the 2-year course of corneal densitometry following Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED). DESIGN Retrospective, interventional case series. METHODS Densitometry values (corneal light backscatter in grayscale units) measured by Scheimpflug-based imaging and clinical records of 160 eyes of 160 patients undergoing DMEK for FED were reviewed. Outcome measures included densitometry data in 4 corneal layers (anterior layer [AL], central layer [CL], posterior layer [PL], and total layer [TL]) and 2 annuli (central annular zone 0-2 mm and peripheral zone 2-10 mm), central corneal thickness (CCT), best spectacle-corrected visual acuity (BSCVA), and endothelial cell density (ECD) prior to DMEK and at 1, 3, 6, 12, and 24 months postoperatively. RESULTS Corneal densitometry decreased in all 4 layers over 2 years after DMEK surgery. Regarding TL 0-2 mm, the reduction of corneal light backscatter was statistically significant for all follow-up time points compared with preoperative values (P < .001) and compared in between follow-up periods (P ≤ .010). Corneal light backscatter reduction was significantly higher in the center (0-2 mm) than in the periphery (2-10 mm) for all layers at 12 and 24 months (P ≤ .002). ECD and CCT did not correlate with corneal densitometry, whereas BSCVA correlated moderately for TL 0-2 mm (P = .026; r = 0.449) and TL 2-10 mm (P = .001; r = 0.585) at 12 months. CONCLUSIONS Corneal light backscatter showed a significant reduction after DMEK surgery in Fuchs endothelial dystrophy over a period of 2 years, more pronounced in the corneal center, apparently in association with visual acuity improvement.
Collapse
|
15
|
Nielsen E. Fuchs' endothelial corneal dystrophy: pathology and treatment outcome. Acta Ophthalmol 2016. [DOI: 10.1111/aos.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Esben Nielsen
- Department of Health; Aarhus University; Aarhus Denmark
- Department of Ophthalmology; Aarhus University Hospital; Denmark
| |
Collapse
|
16
|
Heinzelmann S, Böhringer D, Eberwein P, Reinhard T, Maier P. Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 2016; 255:127-133. [DOI: 10.1007/s00417-016-3499-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/11/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022] Open
|
17
|
|
18
|
Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 2016; 254:515-22. [DOI: 10.1007/s00417-015-3248-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022] Open
|
19
|
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]
|
20
|
Turnbull AMJ, Tsatsos M, Hossain PN, Anderson DF. Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol 2015; 61:257-71. [PMID: 26708363 DOI: 10.1016/j.survophthal.2015.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
Endothelial keratoplasty is now favored over full-thickness penetrating keratoplasty for corneal decompensation secondary to endothelial dysfunction. Although endothelial keratoplasty has evolved as surgeons strive to improve outcomes, fewer patients than expected achieve best corrected visual acuity of 20/20 despite healthy grafts and no ocular comorbidities. Reasons for this remain unclear, with theories including anterior stromal changes, differences in graft thickness and regularity, induced high-order aberrations, and the nature of the graft-host interface. Newer iterations of endothelial keratoplasty such as thin manual Descemet stripping endothelial keratoplasty, ultrathin automated Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty have achieved rates of 20/20 acuity of approximately 50%, comparable to modern cataract surgery, and it may be that a ceiling exists, particularly in the older age group of patients. Establishing the relative contribution of the factors that determine visual quality following endothelial keratoplasty will help drive further innovation, optimizing visual and patient-reported outcomes while improving surgical efficacy and safety.
Collapse
Affiliation(s)
- Andrew M J Turnbull
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK.
| | - Michael Tsatsos
- Moorfields Eye Hospital, London, UK; Modern Eye Centre, Thessaloniki, Greece
| | - Parwez N Hossain
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David F Anderson
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; University of Southampton, Southampton, UK
| |
Collapse
|
21
|
Mencucci R, Favuzza E, Tartaro R, Busin M, Virgili G. Descemet stripping automated endothelial keratoplasty in Fuchs' corneal endothelial dystrophy: anterior segment optical coherence tomography and in vivo confocal microscopy analysis. BMC Ophthalmol 2015; 15:99. [PMID: 26253099 PMCID: PMC4545854 DOI: 10.1186/s12886-015-0096-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 07/31/2015] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the in vivo corneal changes using in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in patients with Fuchs’ dystrophy who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) and the relationship between these changes and the postoperative visual recovery up to 1-year follow-up. Methods Before DSAEK and 1 day, 3, 6 and 12 months after surgery 31 patients (39 pseudophakic eyes) underwent a complete ophthalmological evaluation including best corrected visual acuity (BCVA), IVCM (subepithelial haze, interface haze, graft thickness) and AS-OCT (graft thickness). Results Graft thickness measurements by AS-OCT were strongly correlated to those obtained using IVCM at every follow-up stage (intraclass correlation coefficient = 0.95 to 0.97 between 3 and 12 months, P < 0.001 for all coefficients). No correlation between BCVA and graft thickness measured by AS-OCT at any follow-up stage was found, while at 3 and 6 postoperative months the correlations between BCVA and preoperative subepithelial haze (r = 0.61, P < 0.001 and r = 0.46, P = 0.002), interface haze (r = 0.51, P < 0.001 and r = 0.46, P = 0.003), postoperative subepithelial haze (r = 0.43, P = 0.004 and r = 0.39, P = 0.001) were significant. Conclusions The study confirmed corneal subepithelial haze and interface haze as important factors limiting visual acuity after DSAEK, while graft thickness was not related to BCVA.
Collapse
Affiliation(s)
- Rita Mencucci
- Eye Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
| | - Eleonora Favuzza
- Eye Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
| | - Ruggero Tartaro
- Eye Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
| | - Massimo Busin
- Department of Ophthalmology, 'Villa Igea' Hospital, Forlì, Italy.
| | - Gianni Virgili
- Eye Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
| |
Collapse
|
22
|
Kamiya K, Asato H, Shimizu K, Kobashi H, Igarashi A. Effect of Intraocular Forward Scattering and Corneal Higher-Order Aberrations on Visual Acuity after Descemet's Stripping Automated Endothelial Keratoplasty. PLoS One 2015; 10:e0131110. [PMID: 26090889 PMCID: PMC4474429 DOI: 10.1371/journal.pone.0131110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/28/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the relationship of intraocular forward scattering and corneal higher-order aberrations (HOAs) with best spectacle corrected visual acuity (BSCVA) after Descemet’s stripping automated endothelial keratoplasty (DSAEK), and to compare these parameters between DSAEK and non-Descemet’s stripping automated endothelial keratoplasty (n-DSAEK) groups. Methods This retrospective study enrolled thirty eyes of 30 consecutive patients who underwent standard DSAEK, and who underwent successful phacoemulsification with intraocular lens implantation before DSAEK. The mean age at the time of surgery was 71.7 ± 10.4 years. We quantitatively evaluated the objective scattering index (OSI) using the double-pass instrument (OQAS II, Visiometrics) and corneal HOAs using Hartmann-Shack aberrometry (KR-9000PW, Topcon) 3 months postoperatively. Results The mean OSI, corneal HOAs, and logMAR BSCVA 3 months after DSAEK were 7.91 ± 3.58, 0.43 ± 0.27 μm, and 0.32 ± 0.25, respectively. We found a significant correlation between the OSI and logMAR BSCVA (Spearman correlation coefficient r=0.714, p<0.001), but no significant association between corneal HOAs and logMAR BSCVA 3 months postoperatively (r=0.209, p=0.267). We found no significant differences in any postoperative parameters between the DSAEK and n-DSAEK groups (p>0.05). Conclusions Our pilot study demonstrated that the postoperative corrected visual acuity was significantly correlated with intraocular forward scattering, but not with corneal HOAs in post-DSAEK eyes, suggesting that intraocular forward scattering plays a more essential role in postoperative visual performance than corneal aberrations after DSAEK. The detailed visual performance, such as HOAs and intraocular scattering, after n-DSAEK appears to be essentially equivalent to that after DSAEK.
Collapse
Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
- * E-mail:
| | - Hitomi Asato
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Kimiya Shimizu
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Hidenaga Kobashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Akihito Igarashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| |
Collapse
|
23
|
[Perforating keratoplasty versus Descemet stripping automated endothelial keratoplasty in the partner eye: Functional results and patient satisfaction]. Ophthalmologe 2015; 112:848-53. [PMID: 25943048 DOI: 10.1007/s00347-015-0010-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study compared the postoperative results and patient satisfaction between penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients who underwent PK in one eye and DSAEK in the other eye. METHODS A total of 15 patients were identified from the corneal database register and the medical charts were analyzed for best corrected visual acuity (BCVA), keratometric astigmatism, endothelial cell density and postoperative complications. Patient satisfaction was evaluated by a standardized interview. RESULTS Median follow-up time for PK was 55 months and 18 months for DSAEK (p < 0.01). Median BCVA in PK was 0.8 and 0.5 in DSAEK (p = 0.01) at the end of follow-up. Median keratometric astigmatism was 3.1 diopters after PK and 1.9 diopters after DSAEK (p = 0.2). Median endothelial cell density was 831 cells/mm(2) after PK and 860 cells/mm(2) after DSAEK (p = 0.63). For the interventions 57 % of the patients preferred PK, 36 % preferred DSAEK and 7 % were undecided. Patients assigned the better performing eye to the PK side in 64 % and in 29 % to the DSAEK side and 7 % perceived equal visual performance in both eyes. CONCLUSION The results leave doubt about the superiority of DSAEK compared to PK; however, exceptionally good refractive results of the 15 PK eyes analyzed and significantly longer follow-up times after PK could be the reason for the unexpectedly high patient preference for PK.
Collapse
|
24
|
Cabrerizo J, Livny E, Musa FU, Leeuwenburgh P, van Dijk K, Melles GRJ. Changes in Color Vision and Contrast Sensitivity After Descemet Membrane Endothelial Keratoplasty for Fuchs Endothelial Dystrophy. Cornea 2014; 33:1010-5. [DOI: 10.1097/ico.0000000000000216] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Etiopathogenesis and therapy of epithelial ingrowth after Descemet's stripping automated endothelial keratoplasty. BIOMED RESEARCH INTERNATIONAL 2014; 2014:906087. [PMID: 25254218 PMCID: PMC4165875 DOI: 10.1155/2014/906087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/14/2014] [Indexed: 11/17/2022]
Abstract
Descemet's stripping endothelial keratoplasty is an emerging technique finalized to treat endothelial dysfunction replacing only the pathological portion of cornea. The advent of any new technique puts us in front of new complications. The epithelial ingrowth is a well-known complication already studied in case of ocular trauma and more recently in refractive surgery. This job analyzed the potential etiopathogenesis of epithelial ingrowth after DSAEK, reviewing the cases described in literature, and suggests the potential therapy.
Collapse
|
26
|
Postmortem Ultrastructural Analysis of a Cornea Transplanted With Descemet Membrane Endothelial Keratoplasty. Cornea 2014; 33:790-4. [DOI: 10.1097/ico.0000000000000156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
|
28
|
|