Free-Floating DMEK in the Host Anterior Chamber: Surgical Management

Menassa, Nardine; Pagano, Luca; Gadhvi, Kunal A; Coco, Giulia; Kaye, Stephen B.; Levis, Hannah J.; Romano, Vito

doi:10.1097/ico.0000000000002380

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…For this reason, the time to stain the DM not be too longer. 18,19 Instead, the use of a surgical goniolens does not require Trypan blue and areas of incomplete descemetorhexis could be picked up which were otherwise not visible. Another alternative can be the use of air/gas bubble, however the instability of the anterior chamber in the presence of air makes this technique scarcely appreciated by surgeons because of the bothersome leakage of air during the tag removal which consequently leads to loss of tag visibility.…”

Section: Discussionmentioning

confidence: 99%

Surgical goniolens for tag identification and removal in DMEK surgery

Vaccaro

Bosio

Parekh

et al. 2022

European Journal of Ophthalmology

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Introduction We describe a novel technique for identifying endothelial Descemet membrane (DM) tags remaining after descemetorhexis in patients undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery. Methods A surgical goniolens is applied to the corneal surface after descemetorhexis in order to visualize the peripheral inner corneal layer at 360° and identify endothelial-DM tags. Results A detailed visualization of the peripheral inner corneal layer is possible using goniolens, without using any staining in the anterior chamber. Conclusion The technique may be used to screen the posterior corneal surface for any retained endothelial-DM tags. It may to lower the risk of remaining tags and indirectly lower the incidence of DMEK graft detachment.

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Section: Discussionmentioning

confidence: 99%

Surgical goniolens for tag identification and removal in DMEK surgery

Vaccaro

Bosio

Parekh

et al. 2022

European Journal of Ophthalmology

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“…However, the semi-automated or automated classification of graft orientation will most likely be integrated with iOCT: in 2013, Steven and colleagues correlated the intraoperative scrolling properties of DMEK grafts with donor age by mathematically describing the average curvature of the grafts, based on an image analysis of iOCT frames [63]. Building on this concept of curvature in relation to orientation of the graft, the deep learning segmentation of DMEK grafts has been applied to individual iOCT frames to automatically recognize the free-floating graft, compute its local curvature, and predict its orientation, with results comparable to a cornea specialist [68,74].…”

Section: Guiding Descemet Membrane Endothelial Keratoplastymentioning

confidence: 99%

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

Moramarco

Geronimo

Airaldi

et al. 2023

JCM

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Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image.

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“…The trypan blue vital dye is routinely used to allow good visualization of corneal endothelium for quick excision, vital cell assessment, and easy intracameral unfolding EDM for positioning [ 4 , 5 ]. Unfortunately, some studies displayed that trypan blue dye can exert toxic effects on corneal cells and retinal pigment epithelium, forcing the definition of appropriate dosage and exposure times to reduce cytotoxic effects [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

The usefulness of lutein/trypan blue vital dye for the staining of corneal endothelium: a pilot study on DMEK pretreated tissues

Gisoldi

Lodato

Balzamino

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose The study aims to evaluate the usefulness of lutein/trypan blue vital dye for the staining of corneal tissues and endothelium–Descemet membrane (EDM) for Descemet membrane endothelial keratoplasty (DMEK). Methods Sixteen human corneal tissues (Eye Bank, Rome, Italy) were used. Corneal endothelium was tested at 25 s (T0), 1 min (T1), 2 min (T2), and 4 min (T4) from dye addition. Staining intensity and cell counting were compared. Stripped EDM was analyzed for selected apoptotic (AP, caspases, BCL2, BAX) and differentiation (VEGF-A, TGF-β1RI, SMAD3/7, SMA) targets and changes in target expression. Protein extracts were analyzed through SDS-PAGE/IB. Results Although trypan blue staining produced the same color intensity of lutein/trypan blue dye in half the time, lutein/trypan blue reached a good and adequate color intensity at T4, which persisted even on excised and washed EDM grafts. Lutein/trypan blue-stained EDM showed a reduced number of blue-stained cells and AP immunoreactivity was significantly reduced in the same samples. An increased BCL2 transcript and a reduced BAX transcript were detected in lutein/trypan blue-stained EDM. No significant changes were observed for the main effector caspases (3/9) upon both treatments and the target genes representative of endothelial cell trans-differentiation (TGF-β1RI, SMAD3/7, SMA). A trend in vascular endothelial growth factor (VEGF-A) regulation was observed in lutein/trypan blue-treated EDM grafts. Conclusion Obtained results suggest that lutein/trypan blue dye deserves attention in the DMEK field and support the potential routine use of this dye as a valid alternative to trypan blue for all procedures devoted to the assessment of endothelial cell viability and visualization of EDM graft before DMEK grafting. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-022-05909-x.

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Free-Floating DMEK in the Host Anterior Chamber: Surgical Management

Cited by 7 publications

References 25 publications

Surgical goniolens for tag identification and removal in DMEK surgery

Surgical goniolens for tag identification and removal in DMEK surgery

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

The usefulness of lutein/trypan blue vital dye for the staining of corneal endothelium: a pilot study on DMEK pretreated tissues

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