The S-stamp in Descemet Membrane Endothelial Keratoplasty Safely Eliminates Upside-down Graft Implantation

Veldman, Peter B.; Dye, Philip K.; Holiman, Jeffrey D.; Mayko, Zachary M.; Sáles, Christopher S.; Straiko, Michael D.; Galloway, Joshua; Terry, Mark A.

doi:10.1016/j.ophtha.2015.08.044

Cited by 92 publications

(53 citation statements)

References 19 publications

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“…The use of S mark or four asymmetrical marks have been described to identify correct orientation of the DM roll prior to air injection; however, in most of our cases, the exact orientation of S mark was difficult to identify due to corneal haze. 13,14,16 In some cases, although the S mark was apparent in the beginning of the surgery, it became difficult to identify it with passage of time. In all these cases, Mi-OCT helped us in identifying the orientation of the DM roll and correct localization of the endothelial side.…”

Section: Discussionmentioning

confidence: 99%

“…The trephined tissue was lifted to expose the DM and an "S stamp" (Moria, Antony, France) was used to mark the DM endothelium complex. 13,14 Mi-OCT (RESCAN 700, Carl Zeiss Meditec) was used to check if there were any gaps between the Descemet endothelium complex and the underlying stromal bed prior to trephination. ( Figure 1A DMEK roll was checked in the DMEK injector prior to injecting in the anterior chamber.…”

Section: Donor Cornea Preparationmentioning

confidence: 99%

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<p>Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization</p>

Sharma¹,

Sahay²,

Maharana³

et al. 2020

OPTH

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Video AbstractPoint your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/gvUe6EOEWJEPurpose: To assess the utility of microscope-integrated intraoperative optical coherence tomography (Mi-OCT) for performing Descemet membrane endothelial keratoplasty (DMEK) in corneas with poor visualization. Methods: It is a prospective interventional case series that included 25 consecutive cases of corneal decompensation with poor visualization that underwent Mi-OCT-guided DMEK at a tertiary eye care centre. The main outcome measures were graft attachment on day 3 and requirement for re-bubbling.Results: The etiology for corneal decompensation was pseudophakic bullous keratopathy (n=17), Fuchs endothelial corneal dystrophy (n=4), failed graft (n=2), iridocorneal endothelial syndrome (n=1) and failed Descemet stripping automated endothelial keratoplasty (n=1). Complete graft attachment was noted in 72% of cases. Graft detachment was noted in 16% of cases which required re-bubbling. No intervention was done for shallow peripheral detachment (n=2) and peripheral Descemet membrane (DM) fold (n=1). All grafts were attached at six-months follow-up. The mean corrected distance visual acuity and central corneal thickness improved from 1.4 ± 0.5 logMAR and 799.6 ± 110.9 µm at baseline to 0.3 ± 0.3 logMAR and 536.28 ± 11.44 um at six months. Mi-OCT was helpful in visualizing areas of peripheral anterior synechiae, missing DM, retained DM tags after descemetorhexis, DMEK roll configuration and orientation in the injector and anterior chamber, interface fluid and peripheral folds in the DMEK graft. Conclusion: Mi-OCT helps in identification of the anatomy and dynamics of the host DM, DM roll and anterior chamber in cases with poor visualization and is a useful tool while performing DMEK in such cases.

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Section: Discussionmentioning

confidence: 99%

Section: Donor Cornea Preparationmentioning

confidence: 99%

<p>Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization</p>

Sharma¹,

Sahay²,

Maharana³

et al. 2020

OPTH

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show abstract

“…For DMEK surgery, the addition of an "S" stamp to help with graft orientation and the use of SF 6 gas has significantly reduced the rate of iatrogenic primary graft failures and rebubbling rates. 108,109 These advances have made DMEK a leading surgical choice for standard endothelial failure with good anterior chamber visibility.…”

Section: Penetrating Keratoplastymentioning

confidence: 99%

Corneal Edema and Opacification Preferred Practice Pattern®

et al. 2019

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“…Bu sorunu önlemeye yönelik intraoperatif optik koherans tomografi, greft üzerine işaretleme, Moutsouris belirtisi gibi yöntemlerin kullanımı bildirilmiştir. [22][23][24] Çalışmamızda, DM greftinin ÖK'de endotelyal yüz aşağı doğru pozisyonunda açmak için Moutsouris belirtisi kullanıldı. Bir çalışmada, dört vakada ameliyat sonrası ters yüz DM greft tespit edilmiş ve Moutsouris işareti ile doğru pozisyonda greft yeniden yatıştırılmıştır.…”

Section: Discussionunclassified