Relationship Between Tissue Unscrolling Time and Endothelial Cell Loss

Sáles, Christopher S.; Terry, Mark A.; Veldman, Peter B.; Mayko, Zachary M.; Straiko, Michael D.

doi:10.1097/ico.0000000000000771

Cited by 30 publications

(18 citation statements)

References 27 publications

(15 reference statements)

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“…In addition, a retrospective study on 28 eyes observed a positive correlation between ECL and DMEK graft unfolding time [ 59 ]. A similar study on 93 eyes did not observe this association but this may reflect the fact that all surgeries were uncomplicated [ 60 ].…”

Section: Discussionmentioning

confidence: 94%

Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study

Chaussard¹,

Bloch²,

Elnar

et al. 2022

PLoS ONE

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Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015–2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding.

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Section: Discussionmentioning

confidence: 94%

Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study

Chaussard¹,

Bloch²,

Elnar

et al. 2022

PLoS ONE

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“…iOCT also facilitated efficient surgery via rapid identification tissue orientation. Sales et al reported an average unscrolling time of 5.7 +/− 3.9 minutes for S-stamped grafts and 6.4 +/ − 4.4 minutes for non S-stamped grafts [14]. Our average unscrolling time of 4.4 +/− 4.1 minutes compares favorably, especially when viewed in the context of our data including all "learning curve" cases for the primary surgeon as well as six cornea fellows in training.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases

Patel

Goshe

Srivastava

et al. 2020

American Journal of Ophthalmology

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Purpose-Intraoperative optical coherence tomography (iOCT) may facilitate successful transition to descemet membrane endothelial keratoplasty (DMEK) surgery via improved efficiency of tissue orientation. The purpose of this study is to report a large consecutive series of iOCT-assisted DMEK, inclusive of all learning curve cases.Design-Prospective consecutive case series. Methods-The Determination of Feasibility of Intraoperative Spectral Domain MicroscopeCombined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) study is a single-site, multi-surgeon, IRB-approved investigational device prospective study. The first 100 consecutive iOCT-assisted DMEK surgeries performed by one attending corneal surgeon (JMG) and six novice surgeons (cornea fellows under supervision) were reviewed. iOCT was utilized for tissue orientation. Patient demographics, tissue characteristics, intraoperative parameters and postoperative complications are reported.

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“…However, we presume that Asian eyes with shallow anterior chamber tend to have high vitreous pressure, which makes DMEK graft unscrolling quite difficult. There have been two previous reports regarding tissue unscrolling time and endothelial cell loss[ 26 , 27 ]. Although Heinzelmann et al[ 26 ] suggested a relationship between longer unscrolling times and greater endothelial cell loss, Sáles et al[ 27 ] reported no such correlation.…”

Section: Discussionmentioning

confidence: 99%

“…There have been two previous reports regarding tissue unscrolling time and endothelial cell loss[ 26 , 27 ]. Although Heinzelmann et al[ 26 ] suggested a relationship between longer unscrolling times and greater endothelial cell loss, Sáles et al[ 27 ] reported no such correlation. However, in the current study, an analysis of unscrolling time, cell loss rate, and donor age was not performed.…”

Section: Discussionmentioning

confidence: 99%

Development of a Donor Tissue Holding Technique for Descemet’s Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator

Kobayashi¹,

Yokogawa²,

Mori³

et al. 2018

Case Rep Ophthalmol

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Purpose: To report a modified surgical technique called the “donor tissue holding technique for Descemet’s membrane endothelial keratoplasty (DMEK)” using a newly developed 25-gauge graft manipulator. Methods: Six consecutive patients exhibiting endothelial dysfunction were enrolled and treated by DMEK. In brief, after insertion of a DMEK donor into the anterior chamber, the edge of the roll was grasped using a graft manipulator and this grasp was maintained throughout the centering and opening of the roll (holding technique). The following parameters were evaluated in comparison to the previous 10 consecutive DMEK cases in which the no touch technique was used: time of graft unfolding, incidence of intra-/postoperative complications, and best spectacle-corrected visual acuity (BCVA) and endothelial cell density (ECD) 6 months after the procedure. Results: In both technique groups, neither intra- nor postoperative complications were noted in any case. No differences were observed between the two groups in postoperative BCVA (p = 0.88). Also, no differences were observed between the two groups in postoperative ECD (holding technique group: 2,108.3 cells/mm², no touch technique group: 1,491.7 cells/mm²) (p = 0.08) Most notably, the time of graft unfolding prior to filling with air was significantly reduced in the holding technique group (305.5 s) compared to that of the no touch technique group (1,310.0 s; p = 0.01). Conclusions: This donor tissue holding technique enabled rapid and safe DMEK in a reproducible manner, even in Asian eyes with shallow anterior chambers with high vitreous pressure.

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Relationship Between Tissue Unscrolling Time and Endothelial Cell Loss

Abstract: Once the DMEK tissue is safely in the anterior chamber, surgeons need not rush the "DMEK dance" because longer unscrolling times may not endanger the endothelium.

Cited by 30 publications

References 27 publications

Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study

Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study

Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases

Development of a Donor Tissue Holding Technique for Descemet’s Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator

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