Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study

Ruzza, Alessandro; Parekh, Mohit; Avoni, Luca; Wojcik, Gabriela; Ferrari, Stefano; Desneux, Ludovic; Ponzin, Diego; Levis, Hannah J.; Romano, Vito

doi:10.1007/s00417-021-05194-0

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…Investigators have developed various cutting techniques, such as the double-pass method 22 , 23 , slow pass technique 12 , 13 , and drying method 24 , 25 , to obtain thinner DSAEK grafts. However, the simplest or easiest way to obtain thin grafts involves selecting a microkeratome head size that cuts deeper.…”

Section: Discussionmentioning

confidence: 99%

The predictability of graft thickness for Descemet’s stripping automated endothelial keratoplasty using a mechanical microkeratome system

Nishisako

Yamaguchi

Kusano

et al. 2022

Sci Rep

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Descemet's stripping automated endothelial keratoplasty (DSAEK) is used for treating corneal endothelial dysfunction, and the postoperative visual acuity outcome depends on the thickness of the graft. We created a simple nomogram using factors affecting the cutting thickness during graft preparation via a mechanical microkeratome system for DSAEK. This retrospective study was conducted from May 2018 through October 2022 and included donor eyes cut by automatic methods. We measured the graft thickness, cutting accuracy, and assessed ten variables with donor/cornea-related factors potentially affecting the cutting thickness. Subsequently, we created a simple nomogram. We analyzed 81 donor tissues, and the donor median age was 76 years. The mean central graft thickness was 122.2 μm, with 62% of the grafts that could be cut within the target central graft thickness range. Comparatively, donor corneas from those with cardiac diseases were cut deeper (P = 0.007). The developed nomogram provided a 83% probability of estimating the post-cutting graft thickness within 25 µm. Our nomogram, which considers cause of death, enables reproducible production of graft of a desired thickness. A detailed analysis of donor tissues, including the cause of donor death and the characteristics from pressurization to cutting, will enable more precise DSAEK graft preparation.

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Section: Discussionmentioning

confidence: 99%

The predictability of graft thickness for Descemet’s stripping automated endothelial keratoplasty using a mechanical microkeratome system

Nishisako

Yamaguchi

Kusano

et al. 2022

Sci Rep

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“…During graft preparation, either one or two consecutive passes of a microkeratome blade allow for the creation of a very thin lenticule in a procedure known as UltraThin-DSAEK (UT-DSAEK), which has become the standard modern approach to DSAEK [40,45,46]. In cases in which this preparation is carried out in the operating room rather than at the eye bank, iOCT allows the surgeon to easily check the residual stromal thickness, the smoothness of the cut, and the regularity of the UT-DSAEK lenticule [47][48][49][50][51] (Figure 3).…”

Section: Guiding Ultra-thin Descemet Stripping Automated Endothelial ...mentioning

confidence: 99%

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

Moramarco

Geronimo

Airaldi

et al. 2023

JCM

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Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image.

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“…It may result in a thick graft and irregular graft profile hampering the patient's visual quality and go unnoticed until post-operative poor vision is encountered. The AS-OCT allows to assess the DSAEK lenticule following microkeratome pass, ensuring its profile is uniform and its thickness is under 100 microns [50,51]. Handheld ultra sound pachymetry in graft preparation may help with the microkeratome head selection, but it is unreliable at providing graft details (graft thickness and profile) once the microkeratome pass is made.…”

Section: Corneal Transplantationmentioning

confidence: 99%

Role of AS-OCT in Managing Corneal Disorders

et al. 2022

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Optical coherence tomography (OCT) is analogous to ultrasound biometry in the cross sectional imaging of ocular tissues. Development of current devices with deeper penetration and higher resolution has made it popular tool in clinics for visualization of anterior segment structures. In this review, the authors discussed the application of AS-OCT for diagnosis and management of various corneal and ocular surface disorders. Further, recent developments in the application of the device for pediatric corneal disorders and extending the application of OCT angiography for anterior segment are introduced.

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Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study

Cited by 5 publications

References 17 publications

The predictability of graft thickness for Descemet’s stripping automated endothelial keratoplasty using a mechanical microkeratome system

The predictability of graft thickness for Descemet’s stripping automated endothelial keratoplasty using a mechanical microkeratome system

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

Role of AS-OCT in Managing Corneal Disorders

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