Descemet-Stripping Automated Endothelial Keratoplasty

Chen, Edwin S.; Terry, Mark A.; Shamie, Neda; Hoar, Karen L.; Friend, Daniel J.

doi:10.1097/ico.0b013e3181611c50

Cited by 184 publications

(51 citation statements)

References 27 publications

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“…The resulting posterior lamellar grafts often vary considerably in thickness and are typically thicker at the periphery than in the centre. As graft thickness significantly may influence the final visual acuity in the recipient [1], it would be preferable to improve the cutting technique to ensure that the donor grafts are always prepared very thin. The negative optical power of microkeratome prepared grafts also results in a small, but significant hyperopic shift in the refractive power of the recipient [2].…”

Section: Introductionmentioning

confidence: 99%

Inverse Cutting of Posterior Lamellar Corneal Grafts by a Femtosecond Laser

Hjortdal

Nielsen

Vestergaard

et al. 2012

TOOPHTJ

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Purpose Posterior lamellar grafting of the cornea has become the preferred technique for treatment of corneal endothelial dysfunction. Posterior lamellar grafts are usually cut by a micro-keratome or a femto-second laser after the epithelial side of the donor cornea has been applanated. This approach often results in variable central graft thickness in different grafts and an increase in graft thickness towards the periphery in every graft. The purpose of this study was to evaluate if posterior lamellar grafts can be prepared from the endothelial side by a femto-second laser, resulting in reproducible, thin grafts of even thickness.Methods A CZM 500 kHz Visumax femto-second laser was used. Organ cultured donor grafts were mounted in an artifical anterior chamber with the endothelial side up and out. Posterior grafts of 7.8 mm diameter and 130 micron thickness were prepared by femto-second laser cutting. A standard DSAEK procedure was performed in 10 patients with Fuchs endothelial dystrophy. Patients were followed-up regularly and evaluated by measurement of complications, visual acuity, corneal thickness (Pentacam HR), and endothelial cell density.Results Femto-laser cutting of grafts and surgery was uncomplicated. Rebubbling was necessary in 5 of 10 cases (normally only in 1 of 20 cases). All grafts were attached and cleared up during the first few weeks. After six months, the average visual acuity was 0.30 (range: 0.16 to 0.50), corneal thickness was 0.58 mm (range 0.51 to 0.63), and endothelial cell density was 1.570 per sq. mm (range: 1.400 to 2.000 cells per sq. mm). The grafts were of uniform thickness, but substantial interface haze was present in most grafts.Conclusions Posterior lamellar corneal grafts can be prepared from the endothelial side using a femto-second laser. All grafts were clear after 6 months with satisfying endothelial cell counts. Poor visual acuity caused by interface scatter was observed in most patients. Femto-second laser cutting parameters needs to be optimised to enable smooth cutting in the posterior stroma.

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Section: Introductionmentioning

confidence: 99%

Inverse Cutting of Posterior Lamellar Corneal Grafts by a Femtosecond Laser

Hjortdal

Nielsen

Vestergaard

et al. 2012

TOOPHTJ

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“…1–3 In addition, graft survival, which is the standard measure of success for corneal transplantation, 4 at 5 years is similar to that after PK, and endothelial cell loss appears to be lower. 5 Despite these advantages, quality of vision often remains degraded compared to normal 6 with best corrected visual acuity often being less than 20/20, 3,7 and disability glare being higher than normal. 1,6 In fact, poor vision after DSEK has been suggested to be a leading cause of graft replacement during the first five postoperative years.…”

Section: Introductionmentioning

confidence: 99%

Graft Thickness, Graft Folds, and Aberrations After Descemet Stripping Endothelial Keratoplasty for Fuchs Dystrophy

Seery

Nau

McLaren

et al. 2011

American Journal of Ophthalmology

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Purpose To determine whole eye high-order aberrations (HOAs) in pseudophakic eyes after Descemet stripping endothelial keratoplasty (DSEK) for Fuchs dystrophy, and to establish relationships between graft thickness, HOAs, and visual acuity. Design Cross-sectional study. Methods Whole eye HOAs were measured in pseudophakic eyes at intervals through 24 months after DSEK, and in otherwise healthy pseudophakic control eyes implanted with the same type of spherical intraocular lens. Wavefront errors were assessed by a Hartmann-Shack aberrometer over a 4 mm-diameter optical zone. In DSEK eyes, central graft thickness and stromal graft folds were measured by using confocal microscopy in vivo, and best-corrected visual acuity (BCVA) was determined by the electronic Early Treatment of Diabetic Retinopathy Study method. Results Total HOAs at 24 months after DSEK (0.28 ± 0.11 μm, mean ± SD, n=17) were higher than those in pseudophakic controls (0.16 ± 0.07 μm, n=25, p<0.001); specifically, trefoil and quadrafoil were higher after DSEK. At 24 months, total HOAs (r= 0.69, p<0.001) and graft folds (r= 0.41, p= 0.02) were correlated with central graft thickness, and BCVA was correlated with total HOAs (r= 0.39, p=0.01) but not with graft thickness (r= −0.24, p= 0.20, n=27). Conclusions Whole eye HOAs are higher after DSEK compared to untreated corneas. Thicker grafts are associated with increased HOAs and more graft folds, suggesting that the donor lenticule contributes, in part, to the wavefront errors. Although BCVA is weakly related to total HOAs after DSEK, it is not related to graft thickness.

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“…Outstanding results from DSAEK have been reported in the literature. [91011] There have been other cohort studies comparing outcomes of DSAEK in Fuchs’ endothelial dystrophy versus pseudophakic bullous keratopathy in a larger sample size. The present study, however, was performed by a single surgeon which can add new and relevant information for the Middle-Eastern patient population.…”

Section: Discussionmentioning

confidence: 99%

Descemet stripping automated endothelial keratoplasty in Fuchs′ endothelial dystrophy versus pseudophakic bullous keratopathy

Javadi¹,

Feizi²,

Jafari³

et al. 2016

J Ophthalmic Vis Res

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Purpose:To compare clinical and confocal scan outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK) performed for Fuchs’ endothelial dystrophy (FED) versus pseudophakic bullous keratopathy (PBK).Methods:This retrospective comparative study included 47 consecutive eyes of 39 patients with the diagnosis of FED (n = 29, group 1) or PBK (n = 18, group 2) that underwent DSAEK. Clinical outcomes were compared between the study groups. At the final follow-up examination, confocal microscopy was used to measure and compare central corneal and graft thickness as well as endothelial cell density and morphology between the two groups.Results:Mean age at the time of surgery was 65.2 ± 11.8 and 69.4 ± 12.5 years in groups 1 and 2, respectively (P = 0.27). Follow-up period was 23.6 ± 14.0 months in group 1 and 25.6 ± 15.7 months in group 2 (P = 0.79). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 until postoperative month 6. Afterwards, the two study groups were comparable in this regard. At the final follow-up examination, spherical equivalent refractive error was + 0.39 ± 1.46 diopters (D) in group 1 and + 0.80 ± 1.47 D in group 2 (P = 0.45). Postoperative keratometric astigmatism was 1.02 ± 0.83 D and 2.36 ± 0.67 D, respectively (P < 0.001). Mean central graft thickness was 98.0 ± 33.3 μm in group 1 and 107.6 ± 28.0 μm in group 2 (P = 0.45). No statistically significant difference was observed between the two groups in terms of the postoperative endothelial cell density.Conclusion:The outcomes of DSAEK surgery were comparable between FED and PBK. All grafts were clear despite the lower than normal endothelial cell counts.

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Descemet-Stripping Automated Endothelial Keratoplasty

Cited by 184 publications

References 27 publications

Inverse Cutting of Posterior Lamellar Corneal Grafts by a Femtosecond Laser

Inverse Cutting of Posterior Lamellar Corneal Grafts by a Femtosecond Laser

Graft Thickness, Graft Folds, and Aberrations After Descemet Stripping Endothelial Keratoplasty for Fuchs Dystrophy

Descemet stripping automated endothelial keratoplasty in Fuchs′ endothelial dystrophy versus pseudophakic bullous keratopathy

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