A comparative study on different Descemet membrane endothelial keratoplasty graft preparation techniques

Parekh, Mohit; Borroni, Davide; Ruzza, Alessandro; Levis, Hannah J.; Ferrari, Stefano; Ponzin, Diego; Romano, Vito

doi:10.1111/aos.13746

Cited by 44 publications

(40 citation statements)

References 22 publications

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“…The stripping preparation technique with a superficial trephine cut was shown to be accompanied by the lowest cell death rate in comparison to other stripping and bubble techniques. However, it is the most time-consuming and expensive preparation method [2]. The marking of the graft in our study required about 2-3 minutes.…”

Section: Discussionmentioning

confidence: 91%

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How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?

Wasielica‐Poslednik

Schuster

Rauch

et al. 2019

Journal of Ophthalmology

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Purpose. Incorrect anterior-posterior orientation of the Descemet endothelial complex (DEC) is one of the causes of failure of Descemet membrane endothelial keratoplasty (DMEK). We evaluated a new marking technique to avoid such a misorientation. Method. A new marking technique of the DEC was evaluated in patients requiring primary DMEK. A Braille-“R”-letter was applied dot by dot onto the stromal surface of the DEC after lifting it by injecting an air-bubble into the interface between the endothelial surface of the partially stripped graft. The positioning of the graft was intraoperatively controlled by an orientation of the Braille-“R”-letter. Laboratory tests were conducted to test the impact of the marking technique on endothelial cell count. Results. We included prospectively 37 eyes of 30 patients. Four eyes were phakic and 33 pseudophakic. Five grafts (14%) presented an undifferentiated rolling tendency in the anterior chamber, and evaluation of their positioning was possible due to orientation of the mark alone. In case of an upside-down orientation, grafts were flipped immediately. A correct orientation of the graft was achieved in all cases at the end of the surgery. The endothelial cell loss due to the mark was estimated to be less than 0.3%. At 3- and 6-month follow-ups, the mean best-corrected visual acuity was 0.21 ± 0.15 and 0.15 ± 0.11 logMAR, respectively, and endothelial cell density was 1661 ± 349 and 1618 ± 396 cells/mm2, respectively. Only one patient (3%) needed re-bubbling. Conclusions. To rely on the natural rolling tendency of the graft alone does not assure its correct positioning in all cases. Creation of the mark with 4 dots punctuated on the air-lifted stromal side of the DEC is a simple and endothelial cell saving marking method to ensure correct orientation of the graft during DMEK.

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Section: Discussionmentioning

confidence: 91%

“…One of the preconditions for the successful DMEK procedure is a complete and gentle graft preparation. Stripping and bubble-assisted preparation techniques are the most common methods so far [2, 3].…”

Section: Introductionmentioning

confidence: 99%

How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?

Wasielica‐Poslednik

Schuster

Rauch

et al. 2019

Journal of Ophthalmology

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show abstract

“… 149 Studeny and colleagues 161 introduced a hybrid variation of DMEK that retains an outer rim of donor stroma with a centrally bared Descemet’s membrane. Parekh and colleagues 162 compared three stripping techniques and two bubble methods in terms of cost, preparation time, endothelial cell density, and endothelial cell death and morphology. They found a significantly higher cell death rate with pneumatic dissection and submerged hydroseparation than with stripping, which was attributed to the mechanical stress induced by pressure during bubble formation.…”

Section: Corneal Transplantationmentioning

confidence: 99%

“…They found a significantly higher cell death rate with pneumatic dissection and submerged hydroseparation than with stripping, which was attributed to the mechanical stress induced by pressure during bubble formation. 162 However, the preparation time and associated costs were the drawbacks of the stripping methods. 162 …”

Section: Corneal Transplantationmentioning

confidence: 99%

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Corneal endothelial cell dysfunction: etiologies and management

Feizi

2018

Ophthalmol Eye Dis

100

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A transparent cornea is essential for the formation of a clear image on the retina. The human cornea is arranged into well-organized layers, and each layer plays a significant role in maintaining the transparency and viability of the tissue. The endothelium has both barrier and pump functions, which are important for the maintenance of corneal clarity. Many etiologies, including Fuchs’ endothelial corneal dystrophy, surgical trauma, and congenital hereditary endothelial dystrophy, lead to endothelial cell dysfunction. The main treatment for corneal decompensation is replacement of the abnormal corneal layers with normal donor tissue. Nowadays, the trend is to perform selective endothelial keratoplasty, including Descemet stripping automated endothelial keratoplasty and Descemet’s membrane endothelial keratoplasty, to manage corneal endothelial dysfunction. This selective approach has several advantages over penetrating keratoplasty, including rapid recovery of visual acuity, less likelihood of graft rejection, and better patient satisfaction. However, the global limitation in the supply of donor corneas is becoming an increasing challenge, necessitating alternatives to reduce this demand. Consequently, in vitro expansion of human corneal endothelial cells is evolving as a sustainable choice. This method is intended to prepare corneal endothelial cells in vitro that can be transferred to the eye. Herein, we describe the etiologies and manifestations of human corneal endothelial cell dysfunction. We also summarize the available options for as well as recent developments in the management of corneal endothelial dysfunction.

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Using the posterior to anterior corneal curvature radii ratio to minimize the risk of a postoperative hyperopic shift after Descemet membrane endothelial keratoplasty

Diener¹,

Eter²,

Alnawaiseh³

2020

Graefes Arch Clin Exp Ophthalmol

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A comparative study on different Descemet membrane endothelial keratoplasty graft preparation techniques

Abstract: Graft preparation using Sinskey hook (M2) and donor punch (M3) are reliable methods in terms of efficiency and quality with acceptable range of ECL. The preparation time and associated costs could be a limitation for M3.

Cited by 44 publications

References 22 publications

How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?

How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?

Corneal endothelial cell dysfunction: etiologies and management

Using the posterior to anterior corneal curvature radii ratio to minimize the risk of a postoperative hyperopic shift after Descemet membrane endothelial keratoplasty

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