Descemet's Stripping Endothelial Keratoplasty: Safety and Outcomes

Lee, W. Barry; Jacobs, Deborah S.; Musch, David C.; Kaufman, Stephen C.; Reinhart, William J.; Shtein, Roni M.

doi:10.1016/j.ophtha.2009.06.021

Cited by 568 publications

(476 citation statements)

References 145 publications

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“…These include its low biomechanical stiffness and rapid biodegradation. Further, the high rate of enzymatic degradation of natural collagen in vivo makes stabilization of collagen-based biomaterials necessary (Lee et al, 2001;Ma et al, 2004). Moreover, for tissue engineering, previous studies have demonstrated that high mechanical strength is important for biodegradable polymer scaffolds (Hoerstrup et al, 2000;Shinoka et al, 1995;Shinoka et al, 1998;Stock et al, 2000) or allogenic acellular matrix scaffolds (Steinhoff et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Although corneal transplantation and Descemet's stripping endothelial keratoplasty (DSEK) have a high success rate (Lee et al, 2009), the shortage of donor corneas remains a problem. Moreover, successful human corneal allografts not only depend upon the availability of donor corneas but also are detrimentally affected by aggressive immune responses.…”

Section: Introductionmentioning

confidence: 99%

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A new fish scale-derived scaffold for corneal regeneration

Lin

Ritch²,

Lin³

et al. 2010

eCM

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The purpose of this study is to develop a novel scaffold, derived from fish scales, as an alternative functional material with sufficient mechanical strength for corneal regenerative applications. Fish scales, which are usually considered as marine wastes, were acellularized, decalcified and fabricated into collagen scaffolds. The microstructure of the acellularized scaffold was imaged by scanning electron microscopy (SEM). The acellularization and decalcification treatments did not affect the naturally 3-dimentional, highly centrally-oriented micropatterned structure of the material. To assess the cytocompatibility of the scaffold with corneal cells, rabbit corneal cells were cultured on the scaffold and examined under SEM and confocal microscopy at different time periods. Rapid cell proliferation and migration on the scaffold were observed under SEM and confocal microscopy. The highly centrallyoriented micropatterned structure of the scaffold was beneficial for efficient nutrient and oxygen supply to the cells cultured in the three-dimensional matrices, and therefore it is useful for high-density cell seeding and spreading. Collectively, we demonstrate the superior cellular conductivity of the newly developed material. We provide evidences for the feasibility of the scaffold as a template for corneal cells growth and migration, and thus the fish scale-derived scaffold can be developed as a promising material for tissue-engineering of cornea.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A new fish scale-derived scaffold for corneal regeneration

Lin

Ritch²,

Lin³

et al. 2010

eCM

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“…IOL selection took into account the expected hyperopic shift often induced by endothelial keratoplasty. 2, 5 The corneal epithelium was removed prior to biometry in those patients with significant preoperative corneal oedema, preventing accurate biometry measurement.…”

Section: Methodsmentioning

confidence: 99%

Endothelial cell loss and complication rates with combined Descemets stripping endothelial keratoplasty and cataract surgery in a UK centre

Jones

Fajgenbaum

Hollick

2015

Eye

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Purpose To report 6-month, 1-and 2-year endothelial cell loss (ECL), intra-and postoperative complications in a large series of patients undergoing either Descemets stripping endothelial keratoplasty (DSEK) or a combined phacoemulsification and DSEK in a UK centre. Patients and methods Patients undergoing DSEK with or without concurrent cataract surgery were included in this retrospective study. Surgeries were performed between January 2006 and May 2013. Main outcomes included intra-and postoperative complications and percentage ECL.Results DSEK was performed in 226 eyes (210 patients). Of these, 141 eyes (126 patients) underwent DSEK alone and 85 eyes (84 patients) underwent DSEK combined with cataract surgery. Excluding complex anterior segment pathology the mean percentage ECL at 6, 12 and 24 months was 40.5 ± 13.4, 45.1 ± 14.6 and 53.1 ± 13.0 in the DSEK group and 40.7 ± 15.4, 42.6 ± 15.3 and 49.6 ± 16.5 in patients undergoing the combined procedure, respectively. There was no significant difference in percentage ECL at 6 or 24 months between the two groups both in complex and routine cases. Intraoperative complications occurred in four patients undergoing DSEK and three undergoing combined procedure. Postoperative complication rates did not reach statistical significance between the groups. Conclusion Mean ECL and complication rates were comparable at 6, 12 and 24 months in routine cases undergoing concurrent DSEK with cataract surgery and those undergoing DSEK. These data support the combined procedure in patients requiring both cataract surgery and endothelial keratoplasty. Further collaboration to report endothelial cell counts from other UK centres should be encouraged.

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“…Doenças de eleição para estes procedimentos são a distrofia de Fuchs, ceratopatias bolhosas, síndrome endotelial iridocorneal ou falência de transplante penetrante (6) . Nos últimos anos, complicações relacionadas ao procedimento foram descritas na literatura (7)(8)(9)(10)(11)(12)(13) . DSEK fornece mais rápida reabilitação visual e um perfil de segurança aprimorada em comparação com o padrão da ceratoplastia penetrante, principalmente no que diz respeito à ferida operatória e complicações relacionadas à sutura, além do risco menor de hemorragia transoperatória (7) .…”

Section: Complicações Em Ceratoplastia Endotelial Com Desnudamento Daunclassified

Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK)

Moura¹,

Oliveira²,

Tognon³

et al. 2013

Arq. Bras. Oftalmol.

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INTRODUÇÃOO transplante endotelial foi descrito inicialmente em modelo animal em 1993 por Ko et al.(1) e mais tarde, em 1998, Melles et al.publicaram o primeiro transplante endotelial em humanos. Em 1999, iniciaram-se os estudos com a ceratoplastia endotelial lamelar profunda (DLEK, do inglês, "deep lamellar endothelial keratoplasty"), que consiste na retirada de lamela posterior do receptor, com a inserção do botão doador e colocação na bolsa criada anteriormente (3) . A técnica de ceratoplastia endotelial por desnudamento endotelial (DSEK, do inglês, "Descemet stripping endothelial keratoplasty") foi concebida em 2005 (4) , Nessa técnica é realizada a retirada da membrana de Descemet do receptor, com subsequente inserção RESUMO Objetivo: Descrever a taxa de complicações e os tipos de complicações intraoperatórias e pós-operatórias da ceratoplastia endotelial com desnudamento da Descemet (DSEK (46,2%). A cirurgia mais comumente realizada foi o transplante endotelial isoladamente (DSEK), realizado em 65 olhos (54,6%), seguida do DSEK associado à facoemulsificação de cristalino (PHACO-DSEK) em 47 olhos (39,5%) e DSEK associado a outras cirurgias (7 olhos, 5,9%). Oito pacientes foram excluídos do trabalho devido informações cirúrgicas insuficientes em prontuário médico. Em relação às complicações cirúrgicas transoperatórias, foram observados casos isolados de bloqueio pupilar, dissecção irregular do botão, implante reverso do botão, "button-holing" e ruptura de cápsula posterior. Entre as complicações precoces, observou-se descolamento de botão em 21,5% dos olhos no grupo do DSEK, 34,0% no grupo PHACO-DSEK e 57,1% no grupo DSEK associado a outras técnicas cirúrgicas. No que se refere às complicações tardias, observou-se "haze" (opacidade) em interface em 16,9%, 8,5% e 14,2% e glaucoma foi observado em 4,6%, 2,1% e 14,2% dos olhos nos grupos DSEK, PHACO-DSEK e DSEK associado a outras técnicas, respectivamente. Falência pós-rejeição foi observada em 15,3% e 12,7% dos grupos DSEK e PHACO-DSEK, respectivamente. Conclusão: O transplante endotelial de córnea realizado nesta amostra teve uma taxa de complicações considerada alta se comparado aos transplantes penetrantes convencionais. As complicações mais frequentes foram aquelas relacionadas ao descolamento de botão e à falência pós-rejeição. Descritores

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Descemet's Stripping Endothelial Keratoplasty: Safety and Outcomes

Cited by 568 publications

References 145 publications

A new fish scale-derived scaffold for corneal regeneration

A new fish scale-derived scaffold for corneal regeneration

Endothelial cell loss and complication rates with combined Descemets stripping endothelial keratoplasty and cataract surgery in a UK centre

Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK)

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