Posterior Lamellar Keratoplasty Using Descemetorhexis and Organ-Cultured Donor Corneal Tissue (Melles Technique)

Nieuwendaal, Carla P.; Lapid-Gortzak, Ruth; Meulen, Ivanka J. van der; Melles, Gerrit J R

doi:10.1097/01.ico.0000239002.92989.1a

Cited by 55 publications

(44 citation statements)

References 14 publications

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“…Corneoscleral rims were excised and stored by organ culture in modified minimum essential medium (CorneaMax, Eurobio) at 31 C within 48 hours post-mortem ( Figure 1). 18 After 1 week of culture, the endothelial cell morphology and viability of the corneoscleral rims were evaluated with an inverted light microscope (Axiovert 40, Zeiss). After provoked swelling of the cell borders with sucrose 1.8% and staining with trypan blue 0.04%, digital photographs were made (PixeLINK PL-A662, Zeiss) ( Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…After provoked swelling of the cell borders with sucrose 1.8% and staining with trypan blue 0.04%, digital photographs were made (PixeLINK PL-A662, Zeiss) ( Figure 1). 11,18 The corneoscleral rims were then mounted endothelial side up on a custommade holder with a suction cup and DM was loosened at the scleral spur to within the 9.0 mm central area. From the endothelial side, a superficial trephination was made to just within the posterior stroma with a 9.5 mm corneal trephine (Ophtec BV).…”

Section: Methodsmentioning

confidence: 99%

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Donor tissue preparation for Descemet membrane endothelial keratoplasty

Lie

Birbal

Ham

et al. 2008

Journal of Cataract and Refractive Surgery

234

129

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Donor tissue preparation for Descemet membrane endothelial keratoplasty

Lie

Birbal

Ham

et al. 2008

Journal of Cataract and Refractive Surgery

234

129

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“…Moreover, viscoelastic agents are usually necessary and can interfere with endothelial attachment. 11 Dapena et al 1,4 described a no-touch technique for DMEK that uses either a conventional Pasteur glass pipette or a custom-made glass injector. No viscoelastic agent is needed and the glass surfaces are much smoother and can be manufactured without sharp molding edges.…”

Section: Discussionmentioning

confidence: 99%

Double port injector device to reduce endothelial damage in DMEK

Arnalich‐Montiel

Muñoz‐Negrete

Miguel

2014

Eye

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Objective To study endothelial injury from a newly designed asymmetric double port Descemet Membrane Endothelial Keratoplasty (DMEK) injector, both ex-vivo and in clinical practice. Design Laboratory investigation with an interventional case series study. Method Sixteen rabbit endothelial rolls were tested for injection using a no-touch technique. For each pair of rolls, one endothelial graft underwent injection with a single port Pasteur pipette twice, wheras the other was injected with a novel asymmetric double port injector with a larger diameter entry port than the exit port also twice. Each graft was stained with 4-6-diamidino-2-phenylinidole dihydrochloride and was counted under a fluorescence-inverted microscope before and after injection. The proportion of graft injury was calculated and the differences were analyzed. Subsequently, six patients requiring DMEK underwent surgery using this novel insertion device and endothelial cell loss was calculated 3 months after the surgery. Results After injection, the mean proportion of endothelial cell survival with the single port pipette was 78.8% (n ¼ 8; SD: ± 20.9%), whereas the double port injector yielded a survival rate of 96.8% (n ¼ 8; SD: ±8.4%). This difference was statistically significant (P ¼ 0.008), representing less endothelial injury with the double port device. Early endothelial cell loss after 3 months in the DMEK patients was 26.1% (SD: ± 6.1%). Conclusion In our injection model, using a double port injector created significantly less endothelial cell damage than with the single port pipette. Clinically, this device yielded early endothelial cell loss comparable to that of the series performed by experienced DMEK surgeons.

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“…EK has been associated with quicker visual recovery, less postoperative astigmatism, reduced risk of infection and better wound integrity giving it clear advantages over penetrating keratoplasty. 3,4 Inherent differences or limitations of methods used to prepare of donor tissues, result in suboptimal interface and consequently lower vision and overall reduced success with EK procedures. 4,5 A mechanical cut is performed to prepare the posterior lamellar before implantation, it has been hypothesized that femtosecond laser (FL) creates a smoother mechanical cut and smoother stromal surface than the microkeratome (MK).…”

Section: Scanning Electronic Microscopy Evaluation Of the Roughness Omentioning

confidence: 99%

Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria)

Varga

Bergin

Roy³

et al. 2016

Current Eye Research

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Purpose: To compare the stromal bed surface quality and the accuracy of dissection depth after deep lamellar cuts using the Leonardo Da Vinci (LDV) femtosecond laser (Z6) and the ONE Microkeratome. Methods: Deep lamellar cuts were performed on nine human donor corneoscleral buttons: five with the LDV femtosecond (FS) laser (Z6) (Ziemer) and four with the ONE Microkeratome (MK) (Moria). Corneal thickness was measured with ultrasound pachymetry before and after the dissection. The Stromal bed quality was evaluated using light microscopy (n = 4) and scanning electron microscopy (SEM) (n = 9). The surface roughness on SEM images was graded on the scale of 1 (smoothest) to 5 (roughest) by four observers, blinded to the method used. Particle analysis on the SEM images was performed in order to have an objective measure of smoothness. Results: The achieved dissection depth using the FS laser was 496.4 ± 46.4 µm when attempting 500 µm and 474 ± 60 µm with the microkeratome when attempting 350 µm. Histological evaluation of the corneoscleral buttons by both light and electron microscopy showed significantly smoother surface using the FS laser compared to the microkeratome. There were fewer and smaller particles observed in the SEM images of FS laser cut buttons (p < 0.001).The average observer based score of anterior surface roughness (50×) was 2.2 for the FS laser and 3.9 for the microkeratome dissections (p < 0.001). Conclusions: The LDV femtosecond laser (Z6) platform is capable of creating deep corneal lamellar dissection with smoother surface quality and with more predictable cut depth as compared to the One Microkeratome.ARTICLE HISTORY

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Posterior Lamellar Keratoplasty Using Descemetorhexis and Organ-Cultured Donor Corneal Tissue (Melles Technique)

Abstract: PLK can be performed using an organ-cultured donor posterior disk. Visual rehabilitation may be slower than in PLK with fresh donor tissue.

Cited by 55 publications

References 14 publications

Donor tissue preparation for Descemet membrane endothelial keratoplasty

Donor tissue preparation for Descemet membrane endothelial keratoplasty

Double port injector device to reduce endothelial damage in DMEK

Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria)

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