Descemet stripping automated endothelial keratoplasty

Sharma, Namrata; Maharana, Prafulla K.; Singhi, Shipra; Aron, Neelima; Patil, Mukesh

doi:10.4103/ijo.ijo_874_16

Cited by 22 publications

(21 citation statements)

References 98 publications

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“…Results of this study showed acceptable BSCVA in the average duration of one year post DSAEK. BSCVA was almost in the same range as that in prior studies (2,3). New methods of DSAEK including ultrathin and double pass microkeratome technique achieve better BSCVA outcomes.…”

Section: Discussionsupporting

confidence: 77%

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Visual Outcome, Refractive Error and Specular Microscopy Parameters Following Successful DSAEK

et al. 2018

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Background: Descemet stripping and automated endothelial keratoplasty (DSAEK) has gained widespread popularity in the treatment of corneal endothelial dysfunction. In the present study, we evaluated the outcome of DSAEK in our center. Methods: This retrospective cross-sectional study was conducted on 60 patients, who had undergone DSAEK at least 12 months before in Khalili Hospital, Shiraz University of Medical Sciences. On follow-up, best spectacle-corrected visual acuity (BSCVA), refractive errors and specular microscopy parameters were assessed. Results: The majority of the studied eyes (49.2%) had a BSCVA within the range of 20/40 to 20/30. BSCVA was worse than 20/200 in 8 (13.3%) patients; 6 (75%) patients showed graft failure and 2 (25%) patients had graft rejection. Mean post-operative astigmatism was 0.29 ± 1.88 diopters. The mean refractive hyperopic shift was 1.30 ± 1.34 diopters. Specular microscopy indicated that 3 (5.1%) patients had cell density of less than 700 cells/mm 2 , but in none of the patients cell density was less than 500 cells/mm 2. Furthermore, hexagonality of endothelial cells in 50% of the eyes was 54% to 67%. Mean coefficient of variant was 27.76%. Abnormal variations in specular microscopy findings were mostly confined to endothelial cell density, sparing other parameters. Conclusions: In general, results of this study demonstrated acceptable BSCVA in the average duration of one-year post-DSAEK regarding late complications such as graft failure, graft rejection and epithelial downgrowth.

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Section: Discussionsupporting

confidence: 77%

“…Preparation of donor tissue in DSAEK is assisted by an automated microkeratome, which dissects a disc containing the endothelium, Descemet's membrane and a thin layer of posterior stroma (2). A posterior lamellar corneal lenticule is cut from the donor cornea by a microkeratome, which can be set to harvest a desired thickness.…”

Section: Introductionmentioning

confidence: 99%

Visual Outcome, Refractive Error and Specular Microscopy Parameters Following Successful DSAEK

et al. 2018

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“…4). 122 One of the advantages of these EK techniques is that the graft can be fixed without sutures using an air bubble. Once the air resorbs, the graft is unsupported and can detach from the posterior cornea.…”

Section: Resultsmentioning

confidence: 99%

A review of the evidence for in vivo corneal endothelial regeneration

Bogerd

Dhubhghaill

Koppen

et al. 2018

Survey of Ophthalmology

107

104

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Human corneal endothelium has long been thought to be a nonmitotic cell layer with no endogenous reparative potential. Pathologies that damage endothelial function result in corneal decompensation and, if untreated, blindness. The mainstay of treatment involves partial or complete corneal replacement, amounting to 40% of all corneal transplants performed worldwide. We summarize the case reports describing complications postoperatively in the form of (sub)total graft detachment and those resulting in postoperative bare stroma. Complications during cataract and glaucoma surgeries leading to an uncovered posterior cornea are also included. We discuss the newer treatment strategies that are alternatives for current Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty, including partial grafts and stripping of the diseased cell layer. In more than half of the cases reviewed, corneal transparency returned despite incomplete or no corneal endothelial cell transplantation. We question the existing paradigm concerning corneal endothelial wound healing in vivo. The data support further clinical study to determine the safety of simple descemethorexis in central endothelial pathologies, such as Fuchs endothelial corneal dystrophy, where presence of healthy peripheral cells may allow successful corneal recompensation without the need for donor cells.

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“…DSAEK has become the gold standard of EK in recent years due its efficacy, safety, and reproducibilty in achieving optimal visual outcomes. [ 62 63 ] The procedure is fairly reliable with a low rate of complications. Over the past few years, there has been a constant attempt to reduce the graft thickness (GT) without increasing the risk of tissue loss while donor preparation since a thinner graft is associated with a better visual outcome.…”

Section: Classificationmentioning

confidence: 99%

“…In the standard single-pass technique that uses microkeratome head of size 350 μm, the average thickness of harvested endothelial grafts may be 150–250 μm. [ 62 ] In recent times, following two techniques that can harvest thinner donor lenticules are being successfully used:…”

Section: Classificationmentioning

confidence: 99%

Component corneal surgery: An update

Maharana

Sahay

Singhal

et al. 2017

Indian J Ophthalmol

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Several decades ago, penetrating keratoplasty was a challenge to corneal surgeons. Constant effort by the corneal surgeon to improve the outcomes as well as utilization of the available resources has led to a revolutionary change in the field of keratoplasty. All these efforts have led to the evolution of techniques that allow a corneal surgeon to disease-specific transplant of individual layers of corneal “so-called component corneal surgery” depending on the layer of cornea affected. This has led to an improvement in corneal graft survival as well as a better utilization of corneal tissues. This article reviews the currently available literature on component corneal surgeries and provides an update on the available techniques.

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Descemet stripping automated endothelial keratoplasty

Cited by 22 publications

References 98 publications

Visual Outcome, Refractive Error and Specular Microscopy Parameters Following Successful DSAEK

Visual Outcome, Refractive Error and Specular Microscopy Parameters Following Successful DSAEK

A review of the evidence for in vivo corneal endothelial regeneration

Component corneal surgery: An update

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