Descemet Membrane Endothelial Keratoplasty—A Review

Parker, Jack; Parker, John S.; Melles, Gerrit R.J.

doi:10.17925/usor.2013.06.01.29

Cited by 8 publications

(7 citation statements)

References 46 publications

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“…Two principal treatment modalities are currently used, namely Descemet’s stripping endothelial keratoplasty (DSEK) and Descemet’s membrane endothelial keratoplasty (DMEK) 2 . In recent years, DMEK has increased in popularity due to its potential for faster visual recovery and improved visual outcome compared to DSEK 3 , 4 . In both DSEK and DMEK, postoperative detachment of the graft is a relatively common complication 5 – 7 .…”

Section: Introductionmentioning

confidence: 99%

A machine learning approach to explore predictors of graft detachment following posterior lamellar keratoplasty: a nationwide registry study

Muijzer

Hoven²,

Frank³

et al. 2022

Sci Rep

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Machine learning can be used to explore the complex multifactorial patterns underlying postsurgical graft detachment after endothelial corneal transplantation surgery and to evaluate the marginal effect of various practice pattern modulations. We included all posterior lamellar keratoplasty procedures recorded in the Dutch Cornea Transplant Registry from 2015 through 2018 and collected the center-specific practice patterns using a questionnaire. All available data regarding the donor, recipient, surgery, and practice pattern, were coded into 91 factors that might be associated with the occurrence of a graft detachment. In this research, we used three machine learning methods; a regularized logistic regression (lasso), classification tree analysis (CTA), and random forest classification (RFC), to select the most predictive subset of variables for graft detachment. A total of 3647 transplants were included in our analysis and the overall prevalence of graft detachment was 9.9%. In an independent test set the area under the curve for the lasso, CTA, and RFC was 0.70, 0.65, and 0.72, respectively. Identified risk factors included: a Descemet membrane endothelial keratoplasty procedure, prior graft failure, and the use of sulfur hexafluoride gas. Factors with a reduced risk included: performing combined procedures, using pre-cut donor tissue, and a pre-operative laser iridotomy. These results can help surgeons to review their practice patterns and generate hypotheses for empirical research regarding the origins of graft detachments.

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Section: Introductionmentioning

confidence: 99%

A machine learning approach to explore predictors of graft detachment following posterior lamellar keratoplasty: a nationwide registry study

Muijzer

Hoven²,

Frank³

et al. 2022

Sci Rep

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“…Within the decade, DMEK was introduced and is now emerging as the globally preferred standard of care for patients with corneal endothelial disorders. The operation offers the most anatomic restoration of the operated eye because it features an exact one-to-one replacement of diseased recipient tissue with donor material [123].…”

Section: Posterior Lamellar Keratoplastymentioning

confidence: 99%

“…The most common complication of the operation is partial graft detachment, which may occur in 10–20% of operated eyes, but which is correctable by a “rebubbling” procedure to reattach the dislocated tissue [123]. Additionally, the extent of graft detachment may be the biggest predictor of graft failure: while eyes with fully adherent grafts enjoy a 5-year survival rate of 95%, eyes with graft detachments >1/3 of the graft area experience a survival rate of 27% ( p < 0.0001).…”

Section: Posterior Lamellar Keratoplastymentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

et al. 2021

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For nearly a century, the definitive treatment of many corneal dystrophies and ectactic disorders was limited to penetrating keratoplasty, but over the past 2 decades, a surge of surgical innovation has propelled the treatment of many corneal diseases to more targeted approaches with significantly better visual outcomes. Anterior stromal diseases were first changed through endothelial-sparing techniques, such as deep anterior lamellar keratoplasty, but have more recently transitioned to stromal-sparing approaches. Ultraviolet corneal crosslinking strengthens the cornea and halts progression of keratoconus in >90% of cases. Intracorneal ring segment and corneal allogenic ring segment implantation offer methods to flatten ectatic corneas. However, Bowman layer transplantation – inlay and more recently onlay techniques – has shown promise for treating advanced keratoconus and preventing keratoplasty. The advent of endothelial keratoplasty radically changed the treatment of corneal endothelial dysfunction, and Descemet membrane endothelial keratoplasty specifically offers an average postoperative visual acuity of 20/25 (0.8) with only 8.8% of grafts requiring retransplantation in the first 5 years. Here, we review the rapid innovations for surgical treatment of corneal diseases, spanning from endothelial keratoplasty and endothelial regeneration to anterior lamellar keratoplasty and stromal augmentation, highlighting key steps which may be moving us closer to a “postkeratoplasty” world.

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“…DMEK refers to the replacement of the complex of Descemet’s membrane (DM) and the underlying endothelium. It leads to faster and better visual recovery for patients with up to 77% of eyes achieving a best-corrected visual acuity (BCVA) > 20/25 at six months, and with most patients attaining this already by the end of three months [ 10 ]. Furthermore, DMEK has the advantage of reduced allograft rejection rates (<1%) compared to PK (5–15%) and DSAEK (10%) [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of vital dyes on human corneal endothelium and elasticity of Descemet’s membrane

et al. 2017

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The purpose of this study was to evaluate the effects of vital dyes on human Descemet's membranes (DMs) and endothelia. DMs of 25 human cadaveric corneas with research consent were treated with dyes routinely used in Descemet membrane endothelial keratoplasty (DMEK), 0.05% Trypan blue (TB) or a combination of 0.15% Trypan blue, 0.025% Brilliant blue and 4% Polyethylene glycol (commercial name Membrane Blue Dual; MB). The effects of these two dyes on (i) endothelial cell viability, (ii) DM mechanical properties as assessed by atomic force microscopy, and iii) qualitative DM dye retention were tested for two varying exposure times (one or four minutes). No significant differences in cell toxicity were observed between treatments with TB and MB at the two different exposure times (P = 0.21). Further, both dyes led to a significant increase in DM stiffness: exposure to TB and MB for one minute increased the apparent elastic modulus of the DM by 11.2% (P = 8*10−3) and 17.7%, respectively (P = 4*10−6). A four-minute exposure led to an increase of 8.6% for TB (P = 0.004) and 13.6% for MB (P = 0.03). Finally, at 25 minutes, the dye retention of the DM was considerably better for MB compared to TB. Taken together, a one-minute exposure to MB was found to improve DM visibility compared to TB, with a significant increase in DM stiffness and without detrimental effects on endothelial cell viability. The use of MB could therefore improve (i) visibility of the DM scroll, and (ii) intraoperative unfolding, enhancing the probability of successful DMEK surgery.

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Descemet Membrane Endothelial Keratoplasty—A Review

Cited by 8 publications

References 46 publications

A machine learning approach to explore predictors of graft detachment following posterior lamellar keratoplasty: a nationwide registry study

A machine learning approach to explore predictors of graft detachment following posterior lamellar keratoplasty: a nationwide registry study

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

Effect of vital dyes on human corneal endothelium and elasticity of Descemet’s membrane

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