Outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes with failure of primary Descemet membrane endothelial keratoplasty (DMEK)

Graffi, Shmuel; Leon, Pia; Nahum, Yoav; Gutfreund, Shay; Spena, Rossella; Mattioli, Leila; Busin, Massimo

doi:10.1136/bjophthalmol-2017-311834

Cited by 10 publications

(20 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study suggests secondary ultrathin DSAEK (UT-DSAEK) as an alternative treatment option to repeat DMEK in eyes with primary graft failure after DMEK 14. However, the mean preoperative CDVA was 0.62 logMAR and was better than in our study population.…”

Section: Discussioncontrasting

confidence: 72%

<p>Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK</p>

Shajari¹,

Slavík-Lenčová²,

Kohnen³

et al. 2019

OPTH

View full text Add to dashboard Cite

PurposeTo evaluate if repeat Descemet membrane endothelial keratoplasty (DMEK) is appropriate to achieve functional improvements in patients with corneal decompensation from secondary graft failure after primary DMEK.MethodsThis is a retrospective monocentric cohort study including 13 eyes of 13 patients with repeat DMEK for corneal decompensation following primary DMEK. Eyes with primary DMEK only and comparable preoperative corrected distance visual acuity (CDVA) served as control. Main outcome parameter was CDVA. Secondary outcome measures were central corneal thickness (CCT), endothelial cell density, and rebubbling rate (RR).ResultsThe average time interval (±SD) between primary and secondary DMEK was 12.5±6 months. Preoperative CDVA (logMAR) was 1.97±0.90 in the repeat DMEK group and 1.38±0.92 in the primary DMEK group. At 6 months, both groups showed significant improvement in visual acuity (repeat DMEK group, 0.49±0.35, P<0.01 and primary DMEK group, 0.40±0.36, P<0.01). CDVA did not differ significantly between both groups at all time points examined (1, 3, and 6 months postoperatively). Mean CCT values at 3 and 6 months postoperatively did not differ significantly between the two groups (P>0.05). The RR was 23% (n=3) in both groups.ConclusionRepeat DMEK is a useful therapeutic approach in the setting of corneal decompensation following primary DMEK. Functional results of repeat DMEK, visual acuity in particular, are comparable to patients with single DMEK only.

show abstract

Section: Discussioncontrasting

confidence: 72%

<p>Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK</p>

Shajari¹,

Slavík-Lenčová²,

Kohnen³

et al. 2019

OPTH

View full text Add to dashboard Cite

show abstract

“…Clinically, we obtained an average ECD loss of 46.3% at month 6 and 49.1% at month 12, which was similar (or slightly higher) than other cases found in the literature. For instance, the ECD loss reported after 12 months from UT-DSAEK surgery was 49% by Feng et al, 43 38.9% by Graffi et al, 44 and 35.6% by Busin et al 8 For DSAEK, van Cleynenbreugel et al 45 reported a 40.2% loss after 6 months, Guerra et al 46 a 34.9% loss after 12 months, and Javadi et al 47 a 42.8% at 2 years of follow-up. We observed that our cohort showed a large variability on ECD loss at the different time intervals, without a clear pattern ( Fig.…”

Section: Discussionmentioning

confidence: 98%

Deep Learning for Assessing the Corneal Endothelium from Specular Microscopy Images up to 1 Year after Ultrathin-DSAEK Surgery

Vigueras-Guillén

Rooij

Engel

et al. 2020

Trans. Vis. Sci. Tech.

View full text Add to dashboard Cite

Purpose To present a fully automatic method to estimate the corneal endothelium parameters from specular microscopy images and to use it to study a one-year follow-up after ultrathin Descemet stripping automated endothelial keratoplasty. Methods We analyzed 383 post ultrathin Descemet stripping automated endothelial keratoplasty images from 41 eyes acquired with a Topcon SP-1P specular microscope at 1, 3, 6, and 12 months after surgery. The estimated parameters were endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX). Manual segmentation was performed in all images. Results Our method provided an estimate for ECD, CV, and HEX in 98.4% of the images, whereas Topcon's software had a success rate of 71.5% for ECD/CV and 30.5% for HEX. For the images with estimates, the percentage error in our method was 2.5% for ECD, 5.7% for CV, and 5.7% for HEX, whereas Topcon's software provided an error of 7.5% for ECD, 17.5% for CV, and 18.3% for HEX. Our method was significantly better than Topcon's ( P < 0.0001) and was not statistically significantly different from the manual assessments ( P > 0.05). At month 12, the subjects presented an average ECD = 1377 ± 483 [cells/mm 2 ], CV = 26.1 ± 5.7 [%], and HEX = 58.1 ± 7.1 [%]. Conclusions The proposed method obtains reliable and accurate estimations even in challenging specular images of pathologic corneas. Translational Relevance CV and HEX, not currently used in the clinic owing to a lack of reliability in automatic methods, are useful biomarkers to analyze the postoperative healing process. Our accurate estimations allow now for their clinical use.

show abstract

“…The efficacy and safety of DSEK as a technique to treat failed EK or even PKP has been confirmed. [ 12 , 15 , 37 , 38 ] Although DMEK has been used as a method of repeat keratoplasty in developed countries since 2015 [ 39 ], its application in China is rare because of extreme donor shortages and difficulty in graft preparation.…”

Section: Discussionmentioning

confidence: 99%

Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study

Wan

Wang

Zhao

et al. 2021

Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose. To analyze the indications and surgical procedures for repeat keratoplasty in eastern China from 2008 to 2019. Methods. This retrospective descriptive study included 418 eyes of 411 patients who underwent no less than 2 keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2019. Medical charts were reviewed. The primary indications for repeat keratoplasty, the reasons for regrafting, and the surgical techniques used in the treatment were collected and analyzed. Results. Among 418 eyes, 337 eyes (80.6%) had one repeat keratoplasty, and 81 eyes (19.4%) had multiple repeat keratoplasties (≥2 repeat keratoplasties). The median interval between the initial keratoplasty and the first repeat keratoplasty was 25 months, and that between two keratoplasties after the first repeat keratoplasty was 27.5 months. Infectious keratitis was the leading primary indication for single repeat keratoplasty (80 cases, 23.7%) and multiple repeat keratoplasties (19 cases, 23.5%). The second most common primary indication was bullous keratopathy for single repeat keratoplasty (49 eyes, 14.5%) and chemical injury for multiple repeat keratoplasties (14 eyes, 17.3%). The main reason for regrafting was allograft rejection (262 cases, 49.3%), followed by endothelial dysfunction (92 cases, 17.3%), and for vision improvement after tectonic keratoplasty (60 cases, 11.3%). Penetrating keratoplasty (PKP) was the major technique used in repeat keratoplasty (447 cases, 84.2%). However, Descemet stripping endothelial keratoplasty was more frequently used than PKP (72.4% vs. 27.6%, P < 0.001 ) in the treatment of failed endothelial keratoplasty. Conclusion. Infectious keratitis was still the leading cause of repeat keratoplasty in eastern China. Although PKP remains the major technique of repeat keratoplasty, the application of customized lamellar keratoplasty has greatly expanded in the last decade. Cautious selection of indications, surgical techniques, and timing for surgery is crucial for a good prognosis after repeat keratoplasty.

show abstract

Outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes with failure of primary Descemet membrane endothelial keratoplasty (DMEK)

Abstract: UT-DSAEK is instrumental in the management of primary DMEK graft failure, allowing visual rehabilitation which is comparable with that of repeat DMEK.

Cited by 10 publications

References 16 publications

<p>Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK</p>

<p>Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK</p>

Deep Learning for Assessing the Corneal Endothelium from Specular Microscopy Images up to 1 Year after Ultrathin-DSAEK Surgery

Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study

Contact Info

Product

Resources

About