Primary Descemet’s Membrane Endothelial Keratoplasty for Fuchs Endothelial Dystrophy versus Bullous Keratopathy: Histopathology and Clinical Results

Brockmann, Tobias; Brockmann, Claudia; Maier, Anna-Karina B.; Schroeter, Jan; Bertelmann, Eckart; Torun, Necip

doi:10.1080/02713683.2018.1490773

Cited by 11 publications

(4 citation statements)

References 38 publications

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“…Oellerich et al 14 showed similar results in a multicenter study with 2485 eyes with a follow-up of 12 months. In the study by Brockmann et al 15 with 12 months follow-up, again, no significant difference could be observed at the end of the observation period.…”

Section: Discussionmentioning

confidence: 81%

Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy

Zwingelberg

Büscher

Schrittenlocher

et al. 2021

Cornea

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Purpose:The aim of this study was to compare the long-term outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK).Methods:Records of consecutive DMEK surgeries performed between 2015 and 2016 at the Department of Ophthalmology, Cologne, Germany, were retrospectively reviewed from the prospective Cologne DMEK Database. Eyes with either PBK or FECD with a complete 3-year follow-up were enrolled. Main outcome parameters included central corneal thickness (CCT), peripheral corneal thickness (PCT), best spectacle-corrected visual acuity (BSCVA, logarithm of the Minimum Angle of Resolution), and endothelial cell count (ECC) before and after DMEK.Results:Four hundred two eyes from 402 patients were included (FECD n = 371, PBK n = 31). Preoperatively, CCT (FECD: 681.91 ± 146.78 μm; PBK: 932.25 ± 319.84 μm) and PCT (FECD: 732.26 ± 98.22 μm; PBK: 867.54 ± 88.72 μm) were significantly higher in the PBK group (P < 0.01). Three years after DMEK, CCT (FECD: 526.56 ± 27.94 μm; PBK 663.71 ± 132.36 μm) was significantly lower in both groups compared with the preoperative values (P < 0.01), whereas PCT showed no significant difference. PCT increased during the course in the PBK group from month 12 after DMEK (12 mo: 783.73 ± 127.73 μm; 24 mo: 837.50 ± 110.19 μm; 36 mo: 857.79 ± 140.76 μm). The increase in PCT correlated with an accelerated ECC loss starting 12 months after DMEK (P = 0.036). Before DMEK, BSCVA in FECD was significantly higher (P < 0.001) compared with that in PBK. After 3 years, BSCVA improved in FECD and PBK eyes without significant difference (P = 0.239).Conclusions:Visual acuity after DMEK in PBK and FECD seems to be comparable during the long-term follow-up. Peripheral and central corneal edema seems to recur faster in eyes with PBK than in those with FECD. Therefore, using a donor graft with higher ECC or possibly a larger graft could be a promising approach for PBK patients.

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Section: Discussionmentioning

confidence: 81%

Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy

Zwingelberg

Büscher

Schrittenlocher

et al. 2021

Cornea

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“…36 FECD is characterized by disparities in relation to the distribution of collagen and aberrant extracellular matrix, 37 whereas immunohistologic investigations have further demonstrated significant differences in the distribution of matrix proteins between patients with FECD and BK. 38 This could explain a different tissue remodeling taking place in the stroma-to-graft interface in populations with FECD and BK, determining a different rate of initial graft adhesion.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium Inward: A 24-Month Comparative Analysis Between Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy

Viola

Neri

Testa

et al. 2022

Cornea

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Purpose:The aim of this study was to compare long-term clinical outcomes of preloaded Descemet membrane endothelial keratoplasty (DMEK) between Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK).Methods:In this single-center retrospective clinical case series, 71 eyes of 64 patients indicated with FECD (62%) or BK (38%) (with or without cataract) were treated with preloaded DMEK grafts between March 2018 and February 2020. Standard DMEK peeling, followed by manual folding of the tissue with endothelium-inward orientation and storing in a preloaded fashion inside a 2.2-mm intraocular lens cartridge. All tissues were delivered using a bimanual pull-through technique, followed by air tamponade. Graft unfolding time, endothelial cell loss, corrected distance visual acuity, central corneal thickness, rebubbling rate, and intraoperative and postoperative complications at 1, 3, 6, 12, and 24 months were recorded.Results:The mean intraoperative graft unfolding time in FECD did not differ from the BK group (P = 0.6061). Cystoid macular edema did not differ in either group (P = 0.6866). The rebubbling rate was found to be significantly higher in FECD compared with the BK group (P = 0.0423). Corrected distance visual acuity significantly improved at the first month after surgery (P = 0.0012), with no differences between FECD and BK at 24 months (P = 0.2578). Central corneal thickness was stable postoperatively and showed no differences between the groups (P = 0.3693). Significantly higher endothelial cell counts were observed in the FECD group at 24 months (P = 0.0002).Conclusions:Preloaded DMEK with “endothelium-in” offers acceptable intraoperative time, rebubbling rate, and clinical outcomes in both FECD and BK groups. Patients with FECD show better postoperative clinical outcomes even if the rebubbling rate is relatively high.

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“…In the silkworm moth, several other neuron types were described to play a role in pheromone-mediated steering, which can be added to the model for increased complexity and biological relevance. Additionally, complex motor patterns are most likely mediated by not just one cell type, but by a population code across a number of descending neurons [15]. Creating larger and more integrated models of this form is a useful tool for a more complete understanding of these complex interactions.…”

Section: Discussionmentioning

confidence: 99%

“…how it might be integrated in thoracic motor centres to influence behavioural decisions. CX output neurons project to the lateral accessory lobes (LAL; figure 1), a brain region that has been described as a pre-motor centre, because several types of descending neurons that project to thoracic motor centres have post-synaptic endings in the LALs [15]. Whereas a direct effect of neuronal activity in the CX and LALs on thoracic steering reflexes has been shown in cockroaches [16] [17] [18], the anatomical identity of the involved neurons and their place in the CX circuit is not clear.…”

Section: Introductionmentioning

confidence: 99%

A neural model for insect steering applied to olfaction and path integration

Adden

Stewart

Webb

et al. 2020

Preprint

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Many animal behaviours require orientation and steering with respect to the environment. For insects, a key brain area involved in spatial orientation and navigation is the central complex. Activity in this neural circuit has been shown to track the insect's current heading relative to its environment, and has also been proposed to be the substrate of path integration. However, it remains unclear how the output of the central complex is integrated into motor commands. Central complex output neurons project to the lateral accessory lobes (LAL), from which descending neurons project to thoracic motor centres. Here, we present a computational model of a simple neural network that has been described anatomically and physiologically in the LALs of male silkworm moths, in the context of odour-mediated steering. We present and analyze two versions of this network, both implemented in the Nengo framework, one rate-based and one based on spiking neurons. The modelled network consists of an inhibitory local interneuron and a bistable descending neuron (flip-flop), which both receive input in the LAL. The flip-flop neuron projects onto neck motor neurons to induce steering. We show that this simple computational model not only replicates the basic parameters of male silkworm moth behaviour in a simulated odour plume, but can also take input from a computational model of path integration in the central complex and use it to steer back to a point of origin. Furthermore, we find that increasing the level of detail within the model improves the realism of the model's behaviour. Our results suggest that descending neurons originating in the lateral accessory lobes, such as flip-flop neurons, are sufficient to mediate multiple steering behaviours. This study is therefore a first step to close the gap between orientation circuits in the central complex and downstream motor centres.

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Primary Descemet’s Membrane Endothelial Keratoplasty for Fuchs Endothelial Dystrophy versus Bullous Keratopathy: Histopathology and Clinical Results

Abstract: DMEK produces similar results for FED and BK. However, the postoperative course may differ with regard to the recurrence of secondary graft detachments that may be associated by histopathologic particularities.

Cited by 11 publications

References 38 publications

Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy

Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy

Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium Inward: A 24-Month Comparative Analysis Between Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy

A neural model for insect steering applied to olfaction and path integration

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