Descemet-stripping automated endothelial keratoplasty for vitrectomized cases with traumatic aniridia and aphakic bullous keratopathy

Eguchi, Hiroshi; Miyamoto, Tatsuro; Hotta, Fumika; Tomida, Machiko; Inoue, M.; Mitamura, Yoshinori

doi:10.2147/opth.s36850

Cited by 8 publications

(13 citation statements)

References 19 publications

(24 reference statements)

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“…However, no change in rate of keratoplasty was observed for aphakic corneal edema. DSAEK shows the best outcomes when performed in phakic or pseudophakic eyes with diseased endothelium,[ 19 ] as surgery in aphakic, vitrectomized eyes, carries a high risk of lenticule detachment/dislocation, and primary graft failure because of inadequate air tamponade. [ 19 20 ] This explains the preference for PKP in aphakic eyes over DSAEK.…”

Section: Discussionmentioning

confidence: 99%

Changing pattern of utilization of human donor cornea in India

Gogia

Gupta

Agarwal

et al. 2015

Indian J Ophthalmol

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Purpose:To review the changing pattern of donor, corneal utilization in an eye bank at a Tertiary Care Center in Northern India by analyzing the trend in the years 2003, 2008, and 2011.Methods:A retrospective review of eye bank records for 3 years (2003, 2008, and 2011) was performed at the National Eye Bank. Details including a clinical grade of donor cornea, indication of corneal transplantation (therapeutic or optical), type of procedure (penetrating or lamellar keratoplasty [LK]), and clinical diagnosis of the graft recipients were recorded. Primary outcome measure was to observe any preference toward LK, judicious usage of donor corneal tissue, and impact of lamellar corneal transplant in the usage of donor corneas. Secondary outcomes included overall utilization rate and change in trend of indication for keratoplasty.Results:A total of 673, 745, and 864 corneas were retrieved in the years 2003, 2008, and 2011, respectively. The percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011 (P = 0.014); however, this change was reflected only in the usage of nonoptical grade corneas and not for the optical grade corneas. There was an overall increase in lamellar corneal procedures for any clinical grade of cornea (P = 0.0019); number of Descemet's stripping automated endothelial keratoplasty (DSAEK) procedures increased significantly (P < 0.001), particularly for pseudophakic corneal edema (PCE) (P = 0.0085) and failed graft (P = 0.002). Significant increase in the utilization of nonoptical grade corneas was observed over the years (P = 0.005), though the utilization did not increase significantly for optical purposes viz., LK (P = 0.08).Conclusions:Utilization rate of donor corneas increased over the years, primarily due to increase in usage of nonoptical grade corneas for therapeutic purposes. There was a procedural shift toward DSAEK for PCE and failed graft. However, an increase in usage of nonoptical grade corneas for LK, a single donor corneal tissue for two recipients, and retrieval or utilization of optical grade cornea was not observed.

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Section: Discussionmentioning

confidence: 99%

Changing pattern of utilization of human donor cornea in India

Gogia

Gupta

Agarwal

et al. 2015

Indian J Ophthalmol

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“…However, there are specific situations in which some suture might become beneficial. Unicameral eyes present a surgical challenge due to lack of intra-ocular compartmentalization and risk of dislocation into the posterior segment, resulting in possible complications such as corneal decompensation and proliferative vitreoretinopathy [37]. Although no consensus has been agreed upon, several techniques have been described.…”

Section: Endothelial Keratoplasty Dsaek Techniques In Unicameral Eyesmentioning

confidence: 99%

“…A wheel-spoke technique, described by Tanaka et al, has been described in a case of mydriatic bullous keratopathy but may be used for patients with total iris defects [40]. Eguchi et al described a technique in which a double armed 10-0 prolene suture that was originally designed for intraocular lens ciliary sulcus fixation acts as a lifeline for the lenticule DSAEK and as a dress-pin for the lenticule after DSAEK in vitrectomized aphakic eyes [37]. A similar technique has been described by Patel et al; however, both arms are passed through the lenticule prior to insertion, risking suture entanglement and endothelial injury [39].…”

Section: Endothelial Keratoplasty Dsaek Techniques In Unicameral Eyesmentioning

confidence: 99%

Update on Suture Techniques in Corneal Transplantation: A Systematic Review

Pagano

Shah

Ibrahim

et al. 2022

JCM

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Effective suturing remains key to achieving successful outcomes in corneal surgery, especially anterior lamellar keratoplasty and full thickness transplantation. Limitations in the technique may result in complications such as wound leak, infection, or high astigmatism post corneal graft. By using a systematic approach, this study reviews articles and conducts content analysis based on update 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria). The aim of this paper is to summarize the state of the art of corneal suturing techniques for every type of corneal transplant and patient age and also their outcomes regarding astigmatism and complications. Future developments for corneal transplantation will be also discussed. This is important because especially the young surgeon must have knowledge of the implications of every suture performed in order to achieve consistent and predictable post-operative outcomes and also be aware of all the possible complications.

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“…Descemet stripping automated endothelial keratoplasty (DSAEK) has become one of the main surgical procedures to treat bullous keratopathy (BK). As it has become more mainstream, some reports have described the successful use of DSAEK for aniridic or extremely mydriatic aphakic BK without capsule support [ 1 , 2 , 3 , 4 ], which was previously considered difficult to treat. One reason for the challenge is that the barrier between the anterior and posterior chambers, such as the iris or lens capsule, is insufficient, so that the endothelial donor graft can drop from the anterior chamber into the vitreous cavity during intraoperative manipulation.…”

Section: Introductionmentioning

confidence: 99%

Wheel Spokes Technique for Endothelial Keratoplasty for Extremely Mydriatic Bullous Keratopathy Eyes without Capsular Support

Tanaka

Hirano²,

Horiguchi

2018

Case Rep Ophthalmol

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We describe a new technique to prevent an endothelial donor graft from dropping into the vitreous cavity during non-Descemet stripping automated endothelial keratoplasty (nDSAEK) for extremely mydriatic bullous keratopathy (BK) eyes without capsular support. The patient was a 79-year-old woman who underwent nDSAEK for an extremely mydriatic BK eye with an incomplete barrier between the anterior and posterior chambers. She had undergone argon laser iridotomy for acute glaucoma at the age of 59 years and cataract surgery 3 years later. The pupil was extremely mydriatic as a result of iris sphincter muscle damage associated with an acute glaucoma attack and cataract surgery. After cataract surgery, the dislocated intraocular lens (IOL) sometimes touched the corneal endothelium. Despite simultaneous surgery to remove the dislocated IOL and lens capsule, vitrectomy, and intrascleral IOL fixation, her corneal endothelial decompensation progressed to BK. During nDSAEK, three 9-0 Prolene suture threads were placed through the recipient’s cornea, limbus-to-limbus, resembling wheel spokes, to prevent the graft from dropping into the vitreous cavity. With the aid of these pre-placed sutures, the graft was inserted safely and was well attached to the host’s posterior cornea by air tamponade without suturing. The wheel spokes technique prevented the endothelial graft from dropping during intraoperative manipulation, suggesting that nDSAEK is possible even in an extremely mydriatic aphakic BK eye without capsule support.

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Descemet-stripping automated endothelial keratoplasty for vitrectomized cases with traumatic aniridia and aphakic bullous keratopathy

Cited by 8 publications

References 19 publications

Changing pattern of utilization of human donor cornea in India

Changing pattern of utilization of human donor cornea in India

Update on Suture Techniques in Corneal Transplantation: A Systematic Review

Wheel Spokes Technique for Endothelial Keratoplasty for Extremely Mydriatic Bullous Keratopathy Eyes without Capsular Support

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