Comparison of Posterior Lamellar Keratoplasty Techniques to Penetrating Keratoplasty

Bahar, Irit; Kaiserman, Igor; McAllum, Penny; Slomovic, Allan R.; Rootman, David S.

doi:10.1016/j.ophtha.2008.02.010

Cited by 280 publications

(202 citation statements)

References 30 publications

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“…Studies on DSEK/DSAEK generally report a better visual outcome than with PK, with visual acuities up to 20/40 (0.5) in a majority of cases, with only small percentages reaching 20/25 or better (X0.8). 10,11,19,23 Both in PK and DSEK/DSAEK, a final visual acuity is usually achieved at 6-12 months, whereas most DMEK patients reach their maximal visual potential at 1-3 months. 18 When comparing postoperative endothelial cell densities, a second major clinical outcome parameter in keratoplasty surgery, DMEK outcomes may be roughly similar to those after PK or DSEK/DSAEK.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] In 1998, we also described a technique for selective transplantation of Descemet membrane through a self-sealing 3.5 mm clear corneal incision, 13,14 tentatively named Descemet membrane endothelial keratoplasty (DMEK). [15][16][17][18] As PK has been the gold standard for keratoplasty for almost a century, 19 an alternative technique should bring major advantages in clinical outcome, reducing complications as well as technical feasibility, to get accepted and to change a longstanding consensus in ophthalmology. The early forms of endothelial keratoplasty, that is, DLEK and DSEK/ DSAEK, may have shown that the visual outcome could compete with PK, whereas the most frequent long-term complications were minimised.…”

Section: Introductionmentioning

confidence: 99%

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Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Ham

Dapena

Luijk

et al. 2009

Eye

213

142

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Purpose: To evaluate the clinical outcome and complications of Descemet membrane endothelial keratoplasty (DMEK), using Descemet-stripping endothelial keratoplasty (DSEK) as a back-up procedure, in the management of Fuchs endothelial dystrophy. Design: Non-randomised prospective clinical study. Methods: The first fifty consecutive eyes that underwent DMEK, that is, transplantation of an isolated donor Descemet membrane carrying its endothelium, for Fuchs endothelial dystrophy were evaluated. In all eyes, the best-corrected visual acuity (BCVA) as well as the endothelial cell density (ECD) was measured before and at 6 months after surgery, as clinical outcome parameters. Results: Ten patients required a secondary DSEK for failed DMEK. In the remaining 40 DMEK eyes, 95% had a BCVA of X20/40 (X0.5) and 75% X20/25 (X0.8) at 6 months after surgery. ECD averaged 2618 ( ± 201) cells/mm 2 before, and 1876 ( ± 522) cells/mm 2 at 6 months after surgery (n ¼ 35). When the outcomes of DMEK and secondary DSEK procedures were combined, 94% reached a BCVA of X20/40 (X0.5) and 66% X20/25 (X0.8) (n ¼ 47), and ECD averaged 2623 ( ± 193) cells/mm 2 before, and 1815 ( ± 578) cells/mm 2 at 6 months after surgery (n ¼ 43). Conclusion: With DSEK as a back-up procedure, DMEK may provide relatively quick and complete visual rehabilitation in a majority of patients operated on for Fuchs endothelial dystrophy. Endothelial cell survival may be similar to earlier types of (lamellar) keratoplasty. Early graft detachment was the main complication in this first series of DMEK surgeries for Fuchs endothelial dystrophy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Ham

Dapena

Luijk

et al. 2009

Eye

213

142

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“…PK, 18 ALTK, 19 and DSAEK 20 techniques have been extensively described elsewhere. Four interrupted sutures and a single 16-bite 10-0 nylon suture (Ethicon Inc., Somerville, NJ, USA) were placed in all PK and ALTK cases.…”

Section: Methodsmentioning

confidence: 99%

Comparison of iCare tonometer and Goldmann applanation tonometry in normal corneas and in eyes with automated lamellar and penetrating keratoplasty

Salvetat

Zeppieri

Miani

et al. 2011

Eye

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Purpose To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT) and iCare tonometry in normal and post-keratoplasty corneas and to assess the influence of central corneal thickness (CCT), corneal curvature (CC), and corneal astigmatism (CA) on IOP. Methods This prospective cross-sectional study included one eye of 101 subjects with normal corneas (58 healthy subjects, 43 glaucoma); and 90 post-keratoplasty patients: 34 penetrating keratoplasties (PK); 20 automated-lamellar-therapeutic keratoplasties (ALTK); 19 Descemet-stripping-automatedendothelial keratoplasties (DSAEK); 17 edematous grafts. All subjects underwent GAT and iCare IOP measurements in random order, and CCT, CC, and CA evaluation. The Bland-Altman method and multivariate regression analysis were used to assess inter-tonometer agreement and the influence of CCT, CC, and CA on IOP.Results iCare significantly underestimated IOP in all groups compared with GAT (GAT minus iCare of 3.5±3.5 mm Hg, Po0.001), but overestimated IOP in the edematous grafts (GAT minus iCare of À6.5 ± 1.9 mm Hg, Po0.001). In normal corneas, both tonometer measurements were directly related to CCT values; iCare readings appeared inversely related to CC. There was no significant relationship between IOP and CCT, CC and CA in post-keratoplasty eyes, except between CC and iCare measurements for PK eyes. Conclusions The agreement between GAT and iCare was clinically acceptable in control, ALTK and DSAEK groups, and poor in PK and edematous grafts eyes. In normal corneas, GAT was significantly affected by CCT; iCare was influenced by CCT and CC. The iCare appeared less influenced by corneal edema when compared with GAT. High IOP readings taken with both tonometers in grafts should raise suspicion of true elevated IOP.

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“…Many surgeons consider DSAEK as the treatment of choice for this condition (1,2) . According to the potential vision of the eye, a thinner EDL will result in a better final visual acuity.…”

Section: Discussionmentioning

confidence: 99%

“…Its efficacy is indicated by a spectacle-corrected acuity of 20/40 or better in most patients (1,2) . The microkeratome coupled to the artificial chamber can produce an endothelial donor lamella (EDL); however, the cutting irregularities and the unpredictability of the depth of the cut are major impediments to the visual outcome of lamellar transplantation (3,4) .…”

Section: Introductionmentioning

confidence: 99%

In vivoultrathin Descemet stripping automated endothelial keratoplasty with a low-energy and high-frequency femtosecond laser

Victor¹,

Nosé²,

Sousa³

et al. 2014

Arquivos Brasileiros De Oftalmologia

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Comparison of Posterior Lamellar Keratoplasty Techniques to Penetrating Keratoplasty

Cited by 280 publications

References 30 publications

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Comparison of iCare tonometer and Goldmann applanation tonometry in normal corneas and in eyes with automated lamellar and penetrating keratoplasty

In vivoultrathin Descemet stripping automated endothelial keratoplasty with a low-energy and high-frequency femtosecond laser

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