<p>Clinical Outcomes Of Descemet Membrane Endothelial Keratoplasty Using The Bonfadini-Todd Injector For Graft Insertion</p>

Abstract

PurposeTo evaluate the clinical outcomes of using an Alcon intraocular lens (IOL) B cartridge for graft insertion during Descemet membrane endothelial keratoplasty (DMEK).Patients and methodsWe retrospectively reviewed medical charts of patients who underwent DMEK using the Bonfadini-Todd injector, composed of an Alcon IOL B cartridge connected to plastic tubing and a syringe, for graft insertion between May 2016 and August 2018. Patient demographics, diagnoses, donor information, visual acuity, intraocular pressure (IOP), graft position and attachment status, pachymetry, and postoperative complications were recorded.ResultsTwenty-four eyes of 23 patients with an average age of 72.8 ± 10.0 years (range, 48–87 years) were included. Mean follow-up duration was 13.3 ± 6.6 months (range, 3–26 months). Twenty-one (87.5%) patients had a primary diagnosis of Fuchs endothelial dystrophy, two (8.3%) patients had bullous keratopathy and one (4.2%) had Peter’s anomaly. Sixteen (66.7%) cases combined phacoemulsification and IOL implantation. Best-corrected visual acuity improved from a median of 0.398 logMAR preoperatively to 0.097 logMAR (P <0.001) at last follow-up examination, and central corneal thickness decreased from a median of 651 μm to 533.5 μm (P <0.001). Nine of 24 patients (37.5%) required re-bubbling due to partial graft detachment with a mean time of 12.1 ± 9.2 days (range, 5–35 days). One patient (4.2%) developed graft failure after re-bubbling and underwent Descemet stripping endothelial keratoplasty.ConclusionThe Alcon IOL B cartridge for DMEK graft insertion is safe and simple.

Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes

“…[ 30 ] and Ighani et al . [ 29 ] studies had better and worse preoperative BSCVA, respectively (p<0.0001 and p = 0.09). These baseline differences are important because Chaurasia et al .…”

“…A small study by Ighani et al . also did not observe visual acuity differences between triple-DMEK ( n = 16) and pseudophakic-DMEK ( n = 8) at a mean follow-up duration of 13 months (range, 3–26) months [ 29 ]. These findings are also consistent with an earlier case-series study by Laaser et al .…”

“…Consequently, the advent of DMEK for FECD quickly triggered a debate about whether phacoemulsification and DMEK should be conducted in stages or in the same operation (known as phaco-DMEK or triple-DMEK). Three retrospective comparative studies on largely FECD patients have addressed this question in the last decade, with conflicting results: whereas two showed that triple-DMEK and DMEK in pseudophakic eyes yielded equivalent postoperative BSCVA [ 28 , 29 ], the third showed that triple-DMEK associated with better postoperative BSCVA [ 30 ]. However, the two groups in two studies differed markedly in terms of age and/or preoperative BSCVA and one study had a small sample size ( S1 Table ).…”

Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve

“…Ideally, it should facilitate the loading of the graft, cause minimal cell loss/damage to the endothelium, and preserve the AC volume upon insertion. Surgeons may choose from a range of different insertion devices available commercially [50]. In our experience, we found that it was easier to start with glass injectors such as the Geuder glass tube (Geuder AG, Heidelberg, Germany).…”

Descemet Membrane Endothelial Keratoplasty: NGS Metagenomics-Optimized Tissue Preparation and Surgical Technique. Doctoral Thesis

“…We note that Descemet membrane contains elastin and its elastic properties may contribute to the scrolling characteristics of the graft after stripping. [89,90,91,92] We postulate that this may be influenced by the speed of stripping of the Descemet's from the stroma during DMEK graft preparation secondary to the effect and duration of tension on the elastic recoil of the tissue. To our knowledge, no studies have been performed to investigate the effect of the stripping speed on the scrolling behaviour and final graft scroll width resulting in preparation for subsequent DMEK.…”