Long-term Outcomes in Fellow Eyes Comparing DSAEK and DMEK for Treatment of Fuchs Corneal Dystrophy

The aim of this study was to evaluate clinical outcomes and graft survival in a large patient cohort up to 10 years after Descemet membrane endothelial keratoplasty (DMEK) based on surgical indication and Fuchs endothelial corneal dystrophy (FECD) severity. Methods:The cohort in this retrospective study included 750 eyes that underwent DMEK for FECD (86%), bullous keratopathy (BK, 9%), and other indications (5%). Based on the modified Krachmer grading, 186 eyes (29%) had moderate FECD (Krachmer grade 3-4) and 440 eyes (68%) had advanced FECD (Krachmer grade 5-6). Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density (ECD), endothelial cell loss (ECL), postoperative complication rate, and graft survival. Results:The mean 10-year BCVA was 0.08 6 0.28 logMAR (n = 96), and the BCVA remained stable between 5 and 10 years postoperatively (all P . 0.05). The mean ECL at 5 and 10 years was 56% 6 17% (n = 460) and 66% 6 14% (n = 96), respectively (P , 0.05). The 10-year graft survival rate for the total cohort was 0.85 (95% confidence interval, 0.82-0.89). BCVA and ECD differed at 1 to 5 years between eyes with different surgical indications (all P , 0.05), and FECD eyes had higher graft survival compared with BK eyes (0.90 vs. 0.60, P = 0.001). Moderate FECD eyes had better BCVA, ECD, and graft survival outcomes than advanced FECD eyes (all P , 0.05). Minor graft detachment (P = 0.04) and lower donor ECD (P = 0.01) were related to lower 10-year ECD.Conclusions: Long-term outcomes and graft survival after DMEK were better in FECD eyes than BK eyes and were also related to FECD disease severity. Eyes operated for moderate FECD showed the highest graft survival probability and excellent longterm outcomes.

Section: Discussioncontrasting

confidence: 70%

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confidence: 99%

Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Disease Severity

Vasiliauskaitė

Kocaba

Dijk

et al. 2022

“…23 Multiple studies have tried to reduce the exposure to colorants. 24 In this study, we compared pairs of corneas aiming to reduce the differences in the results. 25,26 The improved visualization of the glasses-assisted 3D display system enabled a good quality stripping the DMEK tissues while reducing the staining time to 5 seconds.…”

Section: Discussionmentioning

confidence: 99%

Glasses-Assisted 3D Display System–Guided Descemet Membrane Endothelial Keratoplasty Tissue Preparation

Borroni¹,

Rocha‐de‐Lossada²,

Bonci³

et al. 2022

The aim of this study was to evaluate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) tissue preparation using a glasses-assisted 3-dimensional (3D) display system and to compare it with a conventional surgical microscope.Methods: Healthy pairs of human corneas suitable for penetrating keratoplasty surgery were selected for this study. The tissues were randomly divided into 2 groups. Each pair of corneas had 1 cornea (group 1) prepared with NGENUITY (Alcon) with a 5-second staining time with vision blue, and the fellow cornea (group 2) was prepared using a OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) with a 30-second staining time. DMEK graft preparation time, speed of stripping, graft width, and endothelial cell loss were evaluated.Results: Twenty-eight pairs of corneas were included in this study.The graft preparation time was significantly higher in the 3D group than in the conventional group (498 6 147 vs. 418 6 85 seconds, P value = 0.031). The mean speed of stripping was 0.59 6 0.081 mm/s in group 1 and 0.089 6 0.005 mm/s in group 2 (P value = 0.024). The mean endothelial cell density in group 1 and group 2 before tissue preparation was 2162 6 115.21 and 2153 6 122.45, respectively (P value . 0.1). After tissue preparation, the endothelial cell density reduced to 1911 6 150.72 in group 1 and 1998 6 90.72 in group 2 (P value = P value . 0.05). The graft width was 5.05 6 0.71 mm in group 1 and 4.92 6 0.23 mm in group 2 (P value . 0.05).Conclusions: DMEK tissue preparation with 3D display system NGENUITY is feasible with a slightly increased preparation time. The improved visualization allows a reduced staining time that could be beneficial for eye banks because it may reduce the toxic effect of staining colorants.

“…9,11 Finally, DSAEK is often the most appropriate surgical choice for complicated eyes, including aphakic eyes, eyes with hyperdeep anterior chambers, eyes that have undergone pars plana vitrectomy, eyes with glaucoma drainage devices, or eyes with large iris defects. 9,11…”

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confidence: 99%

“…9 For some surgeons, DSAEK is also often the procedure of choice for less compliant patients because of the need for closer postoperative follow-up and the potential for rebubble procedures with the DMEK procedure. 9,11 Finally, DSAEK is often the most appropriate surgical choice for complicated eyes, including aphakic eyes, eyes with hyperdeep anterior chambers, eyes that have undergone pars plana vitrectomy, eyes with glaucoma drainage devices, or eyes with large iris defects. 9,11 DSAEK surgery requires removal of the recipient Descemet membrane and insertion of donor tissue.…”

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confidence: 99%

Size and Shape Matter: Cell Viability of Preloaded Descemet Stripping Automated Endothelial Keratoplasty Grafts in Three Different Carriers

Straiko,

Sawant,

Hubbs

et al. 2023

Purpose: The aim of this study was to examine endothelial cell loss (ECL) associated with preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) grafts loaded into 3 carriers of different size and shape. Methods: Thirty-six donor corneas were prepared for DSAEK and loaded into an EndoGlide Ultrathin (control) (2.0 mm × 3.5 mm lumen, 4.5 mm/4.9 mm incision for scleral tunnel/clear corneal insertion), Descemet membrane endothelial keratoplasty EndoGlide (experimental) (1.1 mm × 1.7 mm lumen, 2.65 mm incision), or round glass Jones tube (experimental) (1.8 mm lumen, 3.0 mm incision). Control grafts were stored for 6 days in Optisol-GS and experimental grafts stored for 24 hours in Life4C before analysis using Calcein AM staining. Grafts were imaged and ECL was analyzed by FIJI segmentation. The statistical significance of ECL was determined using 1-way ANOVA and Tukey post hoc analysis. Results: There were no significant differences in donor characteristics for grafts in each cohort. ECL for grafts loaded into the EndoGlide Ultrathin was 10.3% ± 2.3% (graft thickness: 60–189 μm, n = 9). ECL for grafts loaded into the Descemet membrane endothelial keratoplasty EndoGlide was 22.2% ± 7.1% (graft thickness: 38–63 μm, n = 9). ECL for thin grafts (34–60 μm, n = 9) loaded into the Jones tube was 24.0% ± 5.0%. ECL for thick grafts (92–119 μm, n = 9) loaded into the Jones tube was 34.2% ± 6.1% ECL (P < 0.001). Combined regression analysis revealed that graft thickness is directly correlated to ECL (P < 0.01). Conclusions: The size and shape of the carrier can influence the cell viability of preloaded DSAEK grafts. Compared with a larger carrier, smaller lumen carriers are associated with greater ECL. In smaller lumen carriers, ECL increases with increasing DSAEK graft thickness.