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Nikola Schmeckenbächer, Andreas Frings, Friedrich E Kruse, Theofilos Tourtas
PURPOSE: To analyze the role of initial intraoperative intraocular pressure (IOP) in graft adhesion in Descemet membrane endothelial keratoplasty (DMEK) during early follow-up. METHODS: This retrospective, observational, single-center case series included 118 eyes from 118 consecutive patients treated between May and July 2015 for DMEK or combined DMEK and phacoemulsification (triple-DMEK). Exclusion criteria were previous eye surgery other than cataract surgery, loss of follow-up, any application of IOP-lowering medication before and after surgery, and low intraindividual repeatability of IOP measurements...
October 14, 2016: Cornea
Zachary M Mayko, Beth Ann Benetz, Harry Menegay, Christopher P Donovan, Christopher G Stoeger, Mark A Terry, Jonathan H Lass
PURPOSE: To evaluate a single eye bank's measurement of endothelial cell density (ECD) of Descemet membrane endothelial keratoplasty (DMEK) grafts before and after preparation using 2 separate counting methods. METHODS: A series of 60 donor tissues were prepared for DMEK surgery. One to 4 specular images of the central endothelium were taken both before and after preparation, and ECDs were evaluated for a total of 345 unique images. Images were then masked and provided to the Cornea Image Analysis Reading Center (CIARC) for independent analysis...
October 12, 2016: Cornea
Sonja Heinzelmann, Daniel Böhringer, Philipp Eberwein, Thomas Reinhard, Philip Maier
PURPOSE: Although the functional results following DMEK are better than after DSAEK, DSAEK still seems to be the standard procedure, as surgeons fear losing grafts during DMEK graft preparation. Therefore, eye banks offer precut DMEK grafts for direct use by the surgeon. Here, we analysed the functional results and complication rates for a precut technique compared to fresh preparations. METHODS: We retrospectively compared 453 standard to 11 precut (1-2 days before surgery) DMEK cases...
October 8, 2016: Graefe's Archive for Clinical and Experimental Ophthalmology
Thomas M Müller, Robert M Verdijk, Itay Lavy, Marieke Bruinsma, Jack Parker, Perry S Binder, Gerrit R J Melles
PURPOSE: To describe the histologic features of postmortem eyes after Descemet membrane endothelial keratoplasty (DMEK) and their potential clinical implications. DESIGN: Histopathologic study. PARTICIPANTS: Eleven postmortem DMEK corneas of 8 patients who underwent surgery for Fuchs endothelial dystrophy, with an average postoperative time of 4±1.9 years (range, 7 months-6.5 years). METHODS: Eleven corneas transplanted with a DMEK graft were procured after death and processed for light microscopy evaluation...
September 21, 2016: Ophthalmology
Korine van Dijk, Marina Rodriguez-Calvo-de-Mora, Hilde van Esch, Laurence Frank, Isabel Dapena, Lamis Baydoun, Silke Oellerich, Gerrit R J Melles
PURPOSE: To monitor refractive changes after Descemet membrane endothelial keratoplasty (DMEK) and to determine what may influence these changes and the time point of stabilization. METHODS: From 67 pseudophakic DMEK eyes operated on for Fuchs endothelial dystrophy at a tertiary referral center, biomicroscopy, visual acuity, subjective refraction, and Scheimpflug-based corneal tomography data were obtained before and up to 2 years postoperatively. Visual acuity and changes in spherical equivalent (SE), mean anterior and posterior simulated keratometry (Km), and central pachymetry were analyzed...
September 21, 2016: Cornea
Itay Lavy, Robert M Verdijk, Marieke Bruinsma, Hein F Sleddens, Silke Oellerich, Perry S Binder, Gerrit R J Melles
PURPOSE: To identify the origin of corneal endothelial cells (host or donor) present on grafts at various time points after Descemet membrane endothelial keratoplasty (DMEK), using fluorescence in situ hybridization (FISH) of sex chromosomes on post mortem corneas with sex mismatch between the donor and host. METHODS: Corneoscleral buttons of 6 post mortem DMEK eyes of 4 patients, operated for Fuchs endothelial dystrophy, with an average postoperative time of 2...
September 8, 2016: Cornea
Julia M Weller, Ursula Schlötzer-Schrehardt, Friedrich E Kruse, Theofilos Tourtas
PURPOSE: In Descemet membrane endothelial keratoplasty (DMEK), lamellar splitting of the Descemet's membrane (DM) may occur during stripping of host's DM, leaving residual DM on the recipient's DMEK interface. The purpose of this study was to determine the incidence rate of lamellar splitting of DM during DMEK and to describe the ultrastructure of DM in these eyes. DESIGN: Retrospective consecutive case series METHODS: Setting: Institutional, single-center PATIENT POPULATION: 664 eyes with Fuchs endothelial corneal dystrophy (FECD) scheduled for primary DMEK...
September 5, 2016: American Journal of Ophthalmology
Lisanne Ham, Isabel Dapena, Vasilis S Liarakos, Lamis Baydoun, Korine van Dijk, Abbas Ilyas, Silke Oellerich, Gerrit R J Melles
PURPOSE: To evaluate the mid-term outcomes of Descemet membrane endothelial keratoplasty (DMEK) up to 4-7 years postoperatively. DESIGN: Retrospective, consecutive interventional case series. METHODS: A total of 250 consecutive eyes of 209 patients who underwent DMEK at our institute and had potentially at least 4 years of follow-up. Main outcome measures were best corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT), graft survival rate and postoperative complications...
September 5, 2016: American Journal of Ophthalmology
Young Shin Kim, So-Young Jin, Jin Kwon Chung
OBJECTIVES: To describe the first case of Descemet membrane endothelial keratoplasty (DMEK) combined with argon laser photocoagulation and intracameral 5-fluorouracil (5-FU) injection in a patient with epithelial downgrowth after cataract surgery. METHODS: Case report and review of the literature. RESULTS: A 77-year-old female underwent uneventful cataract surgery using a clear corneal incision in her left eye. Six months after surgery, an epithelial cell sheet began to cover the posterior cornea and then spread to the anterior chamber structures, leading to anterior synechia and corectopia at 2 years...
September 7, 2016: Eye & Contact Lens
Thomas M Müller, Itay Lavy, Lamis Baydoun, Jessica T Lie, Isabel Dapena, Gerrit R J Melles
PURPOSE: To describe a further modification of Descemet membrane endothelial keratoplasty (DMEK), using a quarter of an untrephined full-size donor Descemet membrane (DM) sheet ("Quarter-DMEK"). METHODS: A 58-year-old patient underwent Quarter-DMEK for Fuchs endothelial dystrophy in his pseudophakic right eye, with a single quadrant of a full-size, 11.5-mm-diameter DM graft. RESULTS: Best-corrected visual acuity improved from 20/50 (0.4) before surgery to 20/40 (0...
August 31, 2016: Cornea
Lamis Baydoun, Eitan Livny, Lisanne Ham, Marieke Bruinsma, Gerrit R J Melles
PURPOSE: To describe the use of 360-degree Scheimpflug imaging as a diagnostic tool for detection and documentation of subtle corneal changes preceding upcoming allograft rejection after Descemet membrane endothelial keratoplasty (DMEK). METHODS: A total of 17 eyes (16 patients) were diagnosed with clinically manifest allograft rejection 2 to 42 months after DMEK. 360-degree Scheimpflug images of consecutive follow-up examinations (from 3-60 mo) of "asymptomatic" eyes before, during, and after rejection were retrospectively analyzed, to determine which abnormalities could be detected before allograft rejection became clinically manifest...
November 2016: Cornea
Sebastian Siebelmann, Uta Gehlsen, Carolin Le Blanc, Tisha Prabriputaloong Stanzel, Claus Cursiefen, Philipp Steven
PURPOSE: Correct early graft attachment is believed to be crucial for final visual outcome after Descemet membrane endothelial keratoplasty (DMEK). Nonetheless, it is not yet known which imaging technique gives superior results for examining early postoperative graft adherence status. We compared imaging data taken with two different OCT devices to examine the development of graft adherence immediately after DMEK and to determine the superior device in terms of visualization of graft adherence...
August 26, 2016: Graefe's Archive for Clinical and Experimental Ophthalmology
Marcus Ang, Jodhbir S Mehta, Stephen D Newman, Sang Beom Han, Jean Chai, Donald Tan
PURPOSE: To evaluate a novel technique of Descemet membrane endothelial keratoplasty (DMEK) donor insertion using the EndoGlide pull-through device. DESIGN: Prospective, interventional cases series METHODS: We performed DMEK using the EndoGlide technique with a protoype donor carrier device (Descemet Mat or D-Mat) in 30 patients by a single surgeon (including learning curve). Clinical data, donor and recipient characteristics were tracked from our prospective Singapore Corneal Transplant Registry...
August 23, 2016: American Journal of Ophthalmology
Andres Gonzalez, Francis W Price, Marianne O Price, Matthew T Feng
PURPOSE: To assess frequency, associations, and outcomes of full air fill after Descemet membrane endothelial keratoplasty (DMEK). METHODS: This retrospective study reviewed 368 consecutive DMEK cases performed to treat Fuchs dystrophy, bullous keratopathy, or failed keratoplasty. Primary outcomes were air bubble status, intraocular pressure, and incidence of pupil block and air reinjection. RESULTS: Using an air management algorithm, slit-lamp assessment 1 hour after DMEK identified complete air fill in 80/368 eyes (22%)...
November 2016: Cornea
Maninder Bhogal, Karl Matter, Maria S Balda, Bruce D Allan
PURPOSE: To evaluate the effect of media composition and storage method on pre-prepared Descemet's membrane endothelial keratoplasty (DMEK) grafts. METHODS: 50 corneas were used. Endothelial wound healing and proliferation in different media were assessed using a standard injury model. DMEK grafts were stored using three methods: peeling with free scroll storage; partial peeling with storage on the stroma and fluid bubble separation with storage on the stroma. Endothelial cell (EC) phenotype and the extent of endothelial overgrowth were examined...
August 19, 2016: British Journal of Ophthalmology
Robert Hoerster, Tisha P Stanzel, Bjoern O Bachmann, Sebastian Siebelmann, Claus Cursiefen
PURPOSE: To investigate the effect of intensified postoperative topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (Triple-DMEK) on postoperative endothelial cell density (ECD). METHODS: This comparative clinical study with historical controls was conducted at a tertiary hospital, specialized in corneal surgery. Patients undergoing DMEK or Triple-DMEK are included prospectively in the Cologne DMEK Database. Until April 2014, first week's postoperative standard therapy for lamellar keratoplasties was prednisolone acetate eye drops 1% applied 5× daily...
November 2016: Cornea
Daniel Pilger, Christoph von Sonnleithner, Eckart Bertelmann, Antonia M Joussen, Necip Torun
PURPOSE: To explore the feasibility of femtosecond laser-assisted descemetorhexis (DR) to facilitate Descemet membrane endothelial keratoplasty (DMEK) surgery. METHODS: Six pseudophakic patients suffering from Fuchs' endothelial dystrophy underwent femtosecond laser-assisted DMEK surgery. DR was performed using the LenSx femtosecond laser, followed by manual removal of the Descemet membrane. Optical coherence tomography images were used to measure DR parameters...
October 2016: Cornea
Friederike Schaub, Philip Enders, Jonas Zachewicz, Ludwig M Heindl, Tisha P Stanzel, Claus Cursiefen, Björn O Bachmann
PURPOSE: To investigate whether the impression held by Descemet membrane endothelial keratoplasty (DMEK) surgeons that young donors are less suitable for DMEK is reflected in 1-year postoperative results. DESIGN: Retrospective, comparative, interventional case series. METHODS: Records of 1084 consecutive DMEKs were reviewed and matched with corresponding donor tissue data. Young donors (aged ≤55 years; subgroups: 10-40, 41-55) were compared with old donors (>55 years; subgroups: 56-65, >65)...
October 2016: American Journal of Ophthalmology
Akira Kobayashi, Hideaki Yokogawa, Natsuko Mori, Kazuhisa Sugiyama
BACKGROUND: To report the feasibility of intraoperative spectral domain optical coherence tomography (OCT) using the RESCAN 700 for the visualization and evaluation of precut Descemet's stripping automated endothelial keratoplasty (DSAEK) and prestripped Descemet's membrane endothelial keratoplasty (DMEK) donor tissue. METHODS: Precut DSAEK (n = 11), prestripped DMEK (n = 4) preserved in a viewing chamber were examined by intraoperative OCT. Wholly intact donor corneas for penetrating keratoplasty (PK) (n = 8) were also examined as controls...
2016: BMC Ophthalmology
Salvatore Luceri, Zainab Baksoellah, Abbas Ilyas, Lamis Baydoun, Gerrit R J Melles
PURPOSE: To describe a case that developed "interface fluid syndrome" after previous laser in situ keratomileusis (LASIK) because of Fuchs endothelial dystrophy (FED), which was reversed by Descemet membrane endothelial keratoplasty (DMEK). METHODS: A 58-year-old male patient presented with bilateral visual impairment owing to FED and visually significant cataract. Cataract surgery was carried out in both eyes followed by DMEK in his left eye. RESULTS: After cataract surgery, visual acuity did not improve sufficiently because corneal thickness increased and a fine cleft with interface fluid developed between the LASIK-flap and the residual stromal bed...
August 3, 2016: Cornea
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