Descemet Membrane Endothelial Keratoplasty Learning Curve for Graft Preparation in an Eye Bank Using 645 Donor Corneas

Parekh, Mohit; Ruzza, Alessandro; Romano, Vito; Favaro, Elisa; Baruzzo, Mattia; Salvalaio, Gianni; Grassetto, Andrea; Ferrari, Stefano; Ponzin, Diego

doi:10.1097/ico.0000000000001553

Cited by 34 publications

(28 citation statements)

References 13 publications

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“…Donor preparation by an eye bank can be a valuable option for surgeons because eye bank operators have experience preparing a significant volume of corneas on a daily basis, which reduces the graft preparation time, tissue wastage, and overall costs. 171 , 172 Prestripped DMEK grafts can also be preloaded in an eye bank without additional endothelial cell loss, making the procedure more efficient. 173 , 174 To prevent endothelial cell loss because of the graft scraping against the injector, DMEK tissue is manually tri-folded with the endothelial side inward before being inserted into the cartridge.…”

Section: Corneal Transplantationmentioning

confidence: 99%

Corneal endothelial cell dysfunction: etiologies and management

Feizi

2018

Ophthalmol Eye Dis

105

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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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Section: Corneal Transplantationmentioning

confidence: 99%

Corneal endothelial cell dysfunction: etiologies and management

Feizi

2018

Ophthalmol Eye Dis

105

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“… 16 In order to overcome the graft preparation issues in theatre, the number of pre-loaded tissues offered by the eye bank has increased rapidly. 4–6 It has also been shown that UT-DSAEK shows similar results to DMEK in terms of visual acuity, even if there is still a difference in postoperative complications. 2 17 It is unclear, however, if this can be extrapolated to pre-loaded tissues.…”

Section: Introductionmentioning

confidence: 88%

“…[1][2][3] With the evolution of techniques in EK such as Descemet stripping automated endothelial keratoplasty (DSAEK), ultra-thin DSAEK (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), there was a steepening of the learning curve and complication rates. [4][5][6][7] Advances in the field of eye banking has resulted in preparation and validation of tissues suitable for such selective procedures. 8 Recently, Dunker et al, compared UT-DSAEK and DMEK in a randomised clinical trial and concluded that they did not differ in visual outcome at 12 months, even if the percentage of eyes achieving 20/25 was higher with DMEK.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

et al. 2020

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ObjectiveTo compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK).Methods and analysisComparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures.Results56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01.ConclusionPl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.

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“…Descemet's membrane endothelial keratoplasty (DMEK), introduced by Melles (Melles et al 2006), is a posterior corneal graft technique for various forms of endothelial dysfunction. DMEK requires some technical experience both during the preparation procedure (Birbal et al 2018;Parekh et al 2018) and throughout surgical handling. It has been postulated, therefore, that the latter may be an obstacle for a more widespread use of DMEK than we presently see (Terry 2012;Schrittenlocher et al 2018).…”

Section: Introductionmentioning

confidence: 99%

“…; Parekh et al. ) and throughout surgical handling. It has been postulated, therefore, that the latter may be an obstacle for a more widespread use of DMEK than we presently see (Terry ; Schrittenlocher et al.…”

Section: Introductionmentioning

confidence: 99%

The learning curve for Descemet membrane endothelial keratoplasty performed by two experienced corneal surgeons: a consecutive series of 40 cases

Wubbels

Remeijer

Engel

et al. 2019

Acta Ophthalmologica

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Purpose: To describe the learning curve for Descemet's membrane endothelial keratoplasty (DMEK) in the Rotterdam Eye Hospital and to evaluate safety and visual outcome. Methods: This was a single-centre prospective study of 40 consecutive patients with Fuchs' endothelial dystrophy who underwent a DMEK procedure in the Rotterdam Eye Hospital. The performance of two corneal surgeons, each conducting their first series of 20 procedures, was examined with the cumulative summation test for the learning curve (LC-CUSUM). The surgical procedure was considered unsuccessful when >30% of the graft was not attached at any time during the first 12 postoperative weeks and a mixture of SF 6 (20%) and air (80%) had to be injected in the anterior chamber (rebubbling) to reattach the graft. Also assessed were visual outcome, intraocular pressure and peri-and postoperative complications. Results: In total, nine rebubbling procedures were performed in seven eyes. Following repeated rebubbling, two eyes did not achieve a satisfactory result and secondary surgery was required to restore visual function. Complications were usually manageable. The last 13 DMEK procedures (33%) of this series did not require rebubbling. After 3 months, 86% of the eyes had reached a Snellen visual acuity of 0.5 or more. Conclusion: Together with the two surgeons' personal experience, the aggregate learning curve was considered to justify incorporation of Descemet membrane endothelial keratoplasty as a regular option of the standard of care for endothelial dysfunction in the Rotterdam Eye Hospital.Key words: cornea surgery -cumulative summation test for the learning curve -descemet membrane endothelial keratoplasty -learning curve Acta Ophthalmol. 2020: 98: 74-79

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Descemet Membrane Endothelial Keratoplasty Learning Curve for Graft Preparation in an Eye Bank Using 645 Donor Corneas

Abstract: There is a learning curve for DMEK graft preparation. ECL and tissue wastage can be reduced with practice and skills. However, each operator may be limited to his or her own learning capability.

Cited by 34 publications

References 13 publications

Corneal endothelial cell dysfunction: etiologies and management

Corneal endothelial cell dysfunction: etiologies and management

Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

The learning curve for Descemet membrane endothelial keratoplasty performed by two experienced corneal surgeons: a consecutive series of 40 cases

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