Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery

Hoerster, Robert; Stanzel, Tisha Prabriputaloong; Bachmann, Björn; Siebelmann, Sebastian; Felsch, Moritz; Cursiefen, Claus

doi:10.1016/j.ajo.2015.12.008

Cited by 83 publications

(79 citation statements)

References 11 publications

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“…However, intense anti‐inflammatory therapy in the first postoperative months was shown not to affect the final endothelial cell count (Hoerster et al. ). Hos et al.…”

Section: Discussionmentioning

confidence: 99%

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Schrittenlocher

Bachmann

Cursiefen

2018

Acta Ophthalmologica

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Purpose To assess the effect of donor tissue diameter in Descemet Membrane Endothelial Keratoplasty (DMEK) on postoperative endothelial cell density (ECD) mainly in Fuchs Endothelial Corneal Dystrophy (FECD) patients. Methods Retrospective review of 693 consecutive DMEK surgeries from the prospective Cologne DMEK database performed between 07/2011 and 07/2016 at the Department of Ophthalmology, University of Cologne. Eight‐ versus ten‐millimetre large donor DMEK grafts of two different surgeons using identical surgical techniques were compared. Results A total of 693 consecutive DMEK surgeries were included. Two groups (8 versus 10 mm DMEK graft diameter) were compared: 23% of eyes received 8‐mm grafts (group 1, n = 160) and 77% 10‐mm grafts (group 2, n = 533). Mean preoperative ECD (±SD) of donor tissue was 2736 ± 224 cells/mm2 in group 1 and 2714 ± 232 in group 2. Group 1 showed a mean ECD of 1740 ± 439 cells/mm2 (mean ± SD; n = 67) 12 months after DMEK compared to 1664 ± 404 cells/mm2 (mean ± SD; n = 344) in group 2. The difference between the 6‐ and 12‐month ECD of both groups was not significant (p = 0.675; p = 0.161). Total decrease in ECD 6‐ and 12‐months postoperatively was 38 ± 14 (n = 128) and 36 ± 16% in group 1 (n = 66) versus 37 ± 15% (n = 398) and 38 ± 15% in group 2 (n = 342; p = 0.414; p = 0.198, respectively). Conclusion Our data suggest that postoperative central endothelial cell density is not significantly associated with DMEK graft diameters in the range of 8–10 mm in cases with healthy peripheral host endothelium (such as FECD).

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“…However, intense anti‐inflammatory therapy in the first postoperative months was shown not to affect the final endothelial cell count (Hoerster et al. ). Hos et al.…”

Section: Discussionmentioning

confidence: 99%

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Schrittenlocher

Bachmann

Cursiefen

2018

Acta Ophthalmologica

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“…11,12 CME has also been described after various keratoplasty techniques such as penetrating keratoplasty, 15 Descemet stripping automated endothelial keratoplasty, 16 and DMEK. 6,7,17,18 The incidence of visually significant postoperative CME is important to quantify. Additionally, to our knowledge, no study has investigated the effect that recent cataract surgery may have on the incidence of CME after DMEK.…”

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confidence: 99%

Incidence of Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty as a Staged and Solitary Procedure

Flanary

Vislisel

Wagoner

et al. 2016

Cornea

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“…and potassium substitution as well as pilocarpine 2% t.i.d. as part of the postoperative standard medication after DMEK [11]. With this treatment, no further IOP peak could be observed.…”

Section: Casementioning

confidence: 99%

“…In order to prevent a pupillary block by the gas bubble, standard operating procedures include the preoperative application of YAG laser iridotomy or perioperative surgical iridectomy in the lower peripheral iris. The standard of care treatment after DMEK surgery includes topical application of dexamethasone every hour as well as antibiotics and miotics three times a day [11]. …”

Section: Introductionmentioning

confidence: 99%

Temporary Filtering Bleb Failure Induced by Anterior Chamber Sulfur Hexafluoride Gas: A Complication after Descemet Membrane Endothelial Keratoplasty

Enders

Avgitidou

Heindl

et al. 2019

Case Rep Ophthalmol

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Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF₆) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF₆ gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF₆ volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF₆ gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery.

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Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery

Cited by 83 publications

References 11 publications

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Incidence of Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty as a Staged and Solitary Procedure

Temporary Filtering Bleb Failure Induced by Anterior Chamber Sulfur Hexafluoride Gas: A Complication after Descemet Membrane Endothelial Keratoplasty

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