Endothelial Keratoplasty: Fellow Eyes Comparison of Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Guerra, Frederico P.; Anshu, Arundhati; Price, Marianne O.; Price, Francis W.

doi:10.1097/ico.0b013e31821ddd25

Cited by 216 publications

(137 citation statements)

References 25 publications

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“…As described by many authors the risk of postoperatively graft detachment is higher after DMEK than after DSAEK. 1,10,18,19 Therefore, a higher rate of air-injections was necessary in eyes after DMEK (50%) than after In both groups, endothelial cell numbers decreased significantly between preoperative and postoperative graft measurements. 1,5,10,32 Endothelial cell loss was comparable between DSAEK and DMEK after 6 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…1,10,18,19 Therefore, a higher rate of air-injections was necessary in eyes after DMEK (50%) than after In both groups, endothelial cell numbers decreased significantly between preoperative and postoperative graft measurements. 1,5,10,32 Endothelial cell loss was comparable between DSAEK and DMEK after 6 months postoperatively. 1,10 The results from our patient questionnaire demonstrate that almost all patients preferred DMEK, if given a choice.…”

Section: Discussionmentioning

confidence: 99%

“…Visual acuity was significantly better following DMEK compared with DSAEK. 1,6,10,[24][25][26] Other studies suggest that the stroma lamella is responsible for a posterior astigmatism, a hyperopic shift and altered higher-order optical aberrations after DSAEK. 1,8,[14][15][16][17]27 In our study, we found no difference in total HOA, astigmatism, and spherical equivalent between DSAEK and DMEK.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] Both procedures are less invasive corneal transplant techniques. In comparison with penetrating keratoplasty main advantages include rapid healing, more predictable refractive outcomes, better corneal integrity, a rapid visual recovery, and fewer postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

Maier

Gundlach

Gonnermann

et al. 2014

Eye

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Purpose In this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient's satisfaction was evaluated. Methods A retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction. Results Best-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16 ± 0.10 vs 0.45 ± 0.58 logMAR, P ¼ 0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49 ± 0.23 vs 0.25±0.18, P ¼ 0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80 ± 1.14 vs 4.50 ± 1.58, P ¼ 0.257), surgery associated pain and burden (DMEK: 1.30 ± 0.48 vs DSAEK: 1.30 ± 0.48, P ¼ 1.0), estimated time for recovery and rehabilitation (27.6 ± 54.0 vs 24.9 ± 54.8 days, P ¼ 0.173), and mean patient satisfaction (5.40 ± 0.84 vs 5.00 ± 1.05, P ¼ 0.257) were evaluated equally. Conclusion Patient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

Maier

Gundlach

Gonnermann

et al. 2014

Eye

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“…4,7 Furthermore, fellow eye comparison studies between DSAEK and DMEK did not show differences. 8,9 Endothelial trauma during surgery can be inflicted during donor graft preparation, insertion, and intraocular unwrapping and positioning.…”

Section: Discussionmentioning

confidence: 99%

Double port injector device to reduce endothelial damage in DMEK

Arnalich‐Montiel

Muñoz‐Negrete

Miguel

2014

Eye

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Objective To study endothelial injury from a newly designed asymmetric double port Descemet Membrane Endothelial Keratoplasty (DMEK) injector, both ex-vivo and in clinical practice. Design Laboratory investigation with an interventional case series study. Method Sixteen rabbit endothelial rolls were tested for injection using a no-touch technique. For each pair of rolls, one endothelial graft underwent injection with a single port Pasteur pipette twice, wheras the other was injected with a novel asymmetric double port injector with a larger diameter entry port than the exit port also twice. Each graft was stained with 4-6-diamidino-2-phenylinidole dihydrochloride and was counted under a fluorescence-inverted microscope before and after injection. The proportion of graft injury was calculated and the differences were analyzed. Subsequently, six patients requiring DMEK underwent surgery using this novel insertion device and endothelial cell loss was calculated 3 months after the surgery. Results After injection, the mean proportion of endothelial cell survival with the single port pipette was 78.8% (n ¼ 8; SD: ± 20.9%), whereas the double port injector yielded a survival rate of 96.8% (n ¼ 8; SD: ±8.4%). This difference was statistically significant (P ¼ 0.008), representing less endothelial injury with the double port device. Early endothelial cell loss after 3 months in the DMEK patients was 26.1% (SD: ± 6.1%). Conclusion In our injection model, using a double port injector created significantly less endothelial cell damage than with the single port pipette. Clinically, this device yielded early endothelial cell loss comparable to that of the series performed by experienced DMEK surgeons.

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Graft Adhesion in Descemet Membrane Endothelial Keratoplasty Dependent on Size of Removal of Host’s Descemet Membrane

et al. 2014

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that reviewed the medical records of 200 consecutive patients undergoing DMEK. Fifty-three eyes of 51 patients undergoing DMEK for Fuchs endothelial dystrophy fulfilling the inclusion criteria were enrolled in this study. Based on intraoperative drawings, postoperative slitlamp examination, and photographs, eyes were divided into 2 groups. The diameter of the descemetorhexis was approximately 10 mm in group A (30 eyes), resulting in a peripheral 1-mm zone of denuded stroma between the graft and the host's Descemet membrane, and approximately 6 mm in group B (23 eyes), resulting in a peripheral 1-mm zone of overlapping between the graft and the host's Descemet membrane. MAIN OUTCOMES AND MEASURESGraft detachment rate, extent of graft detachment (in clock hours of graft's circumference), and rebubbling rate.RESULTS Four days after DMEK, the graft detachment rate was 33.3% (10 of 30) in group A and 78.3% (18 of 23) in group B (P = .002). The mean (SD) extent of graft detachment was 0.6 (0.9) and 2.8 (2.5) clock hours in groups A and B, respectively (P < .001), 4 days after surgery. The rebubbling rate was 6.7% (2 of 30) and 30.4% (7 of 23) for groups A and B, respectively (P = .03). CONCLUSIONS AND RELEVANCEA larger descemetorhexis in DMEK is correlated with better graft adhesion and lower rebubbling rates. Therefore, patients with a larger descemetorhexis require less intensive follow-up.

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Endothelial Keratoplasty: Fellow Eyes Comparison of Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Abstract: The majority of the patients preferred or would recommend the DMEK procedure. Faster visual recovery and better final visual acuity were the main benefits of the DMEK technique.

Cited by 216 publications

References 25 publications

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

Double port injector device to reduce endothelial damage in DMEK

Graft Adhesion in Descemet Membrane Endothelial Keratoplasty Dependent on Size of Removal of Host’s Descemet Membrane

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