Endothelium‐in versus endothelium‐out for Descemet membrane endothelial keratoplasty graft preparation and implantation

Parekh, Mohit; Ruzza, Alessandro; Ferrari, Stefano; Ahmad, Sajjad; Kaye, Stephen B.; Ponzin, Diego; Romano, Vito

doi:10.1111/aos.13162

Cited by 49 publications

(51 citation statements)

References 19 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Migration of endothelial cells to cover the gap between the edge of the graft and host Descemet's membrane and endothelium may not be a consistent event and in this case by 5 months, appeared insufficient to have bridged the circumferential gap of 1.75mm (9.5mm - 7.75mm). 9 On the basis of better graft survival following larger grafts in DSAEK and knowing that the technical difficulties of manipulating a larger graft can be overcome, 10 we would suggest using larger endothelial grafts with a donor trephine size of 9 mm or 9.5 mm. 8 Since there are many factors that contribute to endothelial graft failure, the health of the donor endothelium is likely to be pivotal.…”

Section: Discussionmentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty - Complication and management of a single case for tissue preparation and graft size linked to post-op descemetorhexis disparity

Parekh¹,

Ruzza

Kaye

et al. 2018

American Journal of Ophthalmology Case Reports

Self Cite

View full text Add to dashboard Cite

PurposeTo report the management of an intraoperative complication during large (9.5 mm) ultra-thin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) surgery in a patient with a large area of dysfunctional endothelium.ObservationsA single case study of an 89 y/o male with a history of Fuchs corneal endothelial dystrophy is presented. The patient was listed for a large UT-DSAEK, but due to an intraoperative complication during graft preparation, an 8.00 mm Descemet membrane endothelial keratoplasty (DMEK) was prepared from the same graft using a standardized SCUBA technique and delivered. Early postoperative examination of the graft showed decentred, residual corneal oedema in the absence of DM detachment and a well-formed anterior chamber. The endothelial graft was found attached after 3 months and the corneal oedema was cleared. After 5 months, the patient's BSCVA was recorded at 6/6(20/20) in the left eye, but complained of mild discomfort. A circular ring of corneal oedema was observed around the graft and decentralization of the transplanted graft was observed. Endothelial cell density (ECD) of the central cornea at 5th month was 1506 cells/mm2 at a focal depth of 496 μm with some polymegathism.Conclusionsand importance: It is possible to prepare DMEK starting from a failed DSAEK graft. Thickness map on corneal tomography could be a useful tool after DMEK for checking graft centration, function, and corneal recovery indirectly. It is recommended to only maintain a small distance between the descemetorhexis area and the size of the endothelial graft.

show abstract

Section: Discussionmentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty - Complication and management of a single case for tissue preparation and graft size linked to post-op descemetorhexis disparity

Parekh¹,

Ruzza

Kaye

et al. 2018

American Journal of Ophthalmology Case Reports

Self Cite

View full text Add to dashboard Cite

show abstract

“…Endothelium, if flapped in, does not have statistically more damage compared to endothelium when flapped outward (which is the natural phenomenon) [18]. However, we recommend that the tissues should be flapped in (a) to avoid any possible friction between the endothelial cells and the cartridge during preservation, transportation, and transplantation and (b) to reduce the time of opening the graft inside the recipient eye [18].…”

Section: Discussionmentioning

confidence: 99%

“…However, we recommend that the tissues should be flapped in (a) to avoid any possible friction between the endothelial cells and the cartridge during preservation, transportation, and transplantation and (b) to reduce the time of opening the graft inside the recipient eye [18]. The average endothelial cell loss (ECL) [%] (average of mortality and uncovered areas) after preservation of the preloaded DMEK lenticule was found to be 45.05 (±46.61), 10.77 (±15.99), and 34.77 (±37.37) in C1, C2, and C3, respectively.…”

Section: Discussionmentioning

confidence: 99%

Preservation of Preloaded DMEK Lenticules in Dextran and Non-Dextran-Based Organ Culture Medium

Parekh

Ruzza

Ferrari

et al. 2016

Journal of Ophthalmology

Self Cite

View full text Add to dashboard Cite

Purpose. To determine the optimum preservation conditions for preloading DMEK lenticules using organ culture system. Methods. 8.5 mm DMEK lenticules were stripped and preserved with endothelium flap-in for 4 days at RT in an IOL cartridge that was blocked with rubber stoppers from each end. In C1, tissues were collected from tissue culture medium (TCM) and preserved in TCM. In C2, tissues were collected from transport medium (TCM + 6% dextran T500) (TM) and preserved in TM. In C3, tissues were collected from TCM and preserved in TM. Mortality, glucose uptake, histological staining, tight junctions and cell apoptosis were studied post-preservation. Results. Mortality in C1, C2, and C3 were 49.40%, 8.53%, and 27.74%, with 40.7%, 13%, and 41.8% uncovered areas. Glucose uptake (mg/mL) was 0.32, 0.43, and 0.56 in C1, C2, and C3. PAS staining showed presence of DM and endothelium in C2 but not in C1 and with fewer cells in C3. ZO-1 was expressed in all the conditions. Polymorphism was higher in C1 and C3. Mild apoptosis was observed in C3. Conclusions. Dextran may play an important role in preserving the endothelial cells before and after stripping for trifolded (endothelium-in) preloaded DMEK lenticules.

show abstract

“…Outcomes and complications are described in Table 4 . [ 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 ]…”

Section: Classificationmentioning

confidence: 99%

Component corneal surgery: An update

Maharana

Sahay

Singhal

et al. 2017

Indian J Ophthalmol

View full text Add to dashboard Cite

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.

show abstract

Endothelium‐in versus endothelium‐out for Descemet membrane endothelial keratoplasty graft preparation and implantation

Abstract: Descemet membrane endothelial keratoplasty tissues can be tri-folded (endo-in) with no significantly less cell loss as compared to endo-out. Spontaneous unfolding of endo-in may reduce overall time and surgical manipulation.

Cited by 49 publications

References 19 publications

Descemet Membrane Endothelial Keratoplasty - Complication and management of a single case for tissue preparation and graft size linked to post-op descemetorhexis disparity

Descemet Membrane Endothelial Keratoplasty - Complication and management of a single case for tissue preparation and graft size linked to post-op descemetorhexis disparity

Preservation of Preloaded DMEK Lenticules in Dextran and Non-Dextran-Based Organ Culture Medium

Component corneal surgery: An update

Contact Info

Product

Resources

About