Deep Lamellar Endothelial Keratoplasty

Mashor, Raneen Shehadeh; Kaiserman, Igor; Kumar, Naresh; Sansanayudh, Wiwan; Rootman, David S.

doi:10.1016/j.ophtha.2009.12.039

Cited by 19 publications

(13 citation statements)

References 36 publications

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“…2,12,13 However, an equilibrium may be reached after 1 year where the rate of endothelial cell loss seems to stabilize after EK surgery. 9,12,21 The mean endothelial cell loss after repeat EK in our study was 47.3% over a mean follow-up period of 27 months. A previous prospective study at our institution found the 12-month endothelial cell loss rate after primary DSEK and DSAEK to be 38.2% and 36.4%, respectively.…”

Section: Discussionmentioning

confidence: 47%

“…7 Currently, Descemet stripping endothelial keratoplasty (DSEK)/Descemet stripping automated endothelial keratoplasty (DSAEK) is the most widely performed method of EK. 1,2,8,9 Because EK has become a widely accepted and adopted technique, it is inevitable that EK donor failure will become a more prevalent and important management problem. The risk factors for graft failure in EK include surgery-related donor endothelial trauma (particularly early in the surgeon's learning curve), early postoperative donor dislocation, endothelial rejection, previous glaucoma surgery, and anterior segment abnormalities (including peripheral anterior synechiae).…”

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confidence: 99%

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Outcomes of Repeat Endothelial Keratoplasty in Patients With Failed Descemet Stripping Endothelial Keratoplasty

Kim

Yeung

Lichtinger

et al. 2012

Cornea

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Section: Discussionmentioning

confidence: 47%

mentioning

confidence: 99%

Outcomes of Repeat Endothelial Keratoplasty in Patients With Failed Descemet Stripping Endothelial Keratoplasty

Kim

Yeung

Lichtinger

et al. 2012

Cornea

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“…[20][21][22] An average manifest refraction astigmatism change of +0.28 6 1.08 D was observed with manual DLEK, probably in relation with the large scleral incision required for the host posterior corneal excision. 4 DSAEK has been reported to induce a mean hyperopic shift of about +1.5 D, whereas a clinically insignificant hyperopic shift of +0.4 D has been observed after DMEK.…”

Section: Discussionmentioning

confidence: 99%

Femtosecond Laser-Assisted Deep Lamellar Endothelial Keratoplasty

Barrio

Ziaei

Bhogal

et al. 2015

Cornea

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“…At 5 years after DLEK in Terry’s series, the large incision group had 60% cell loss from preoperative (Figure 2) (personal communication with Mark Terry on 4/10/11), no worse than cell loss after PK. However, in a smaller series of small incision DLEK, endothelial cell loss was 43% at 1 year, and 62% at 4 years (Mashor et al, 2010). The longest reported follow-up for DLEK is 10 years, with 79% endothelial cell loss in 15 surviving grafts (van Dijk et al, 2011).…”

Section: Endothelial Outcomes Of Keratoplastymentioning

confidence: 99%

Graft survival and endothelial outcomes in the new era of endothelial keratoplasty

Patel

2012

Experimental Eye Research

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Corneal endothelial cells do not proliferative in vivo sufficiently to enable endothelial regeneration, and thus diseases of the corneal endothelium, which cause poor vision and discomfort, require treatment by transplantation of cadaveric donor corneal endothelial cells. The two major goals of any corneal transplant procedure are to restore vision and to promote longevity of the donor cornea by maintaining a healthy donor endothelial cell density. Over the last decade, the surgical treatment for endothelial disease has rapidly evolved toward endothelial keratoplasty, or selective tissue transplantation, and away from full-thickness penetrating keratoplasty (PK). While endothelial keratoplasty offers distinct advantages over PK in terms of visual outcomes and a smaller incision, the new surgical manipulations of the fragile donor tissue cause significant donor endothelial cell trauma. As a result, donor endothelial cell loss is much higher during the first month after Descemet stripping endothelial keratoplasty (DSEK) compared to after PK, and the primary (or more appropriately, iatrogenic) graft failure rate of 5% remains unacceptably high. Nevertheless, the rate of endothelial cell loss rapidly decreases beyond 6 months after DSEK, and thus endothelial cell loss at 5 years after DSEK appears to be lower than that at 5 years after PK. In the absence of primary (iatrogenic) graft failure, graft survival through 5 years after DSEK is similar to that after PK. Given the promising longer-term endothelial outcomes of DSEK, the quest for optimizing the visual outcomes has spurred interest in Descemet membrane endothelial keratoplasty (DMEK). While early results after DMEK suggest better visual outcomes than after DSEK, the technique needs to be simplified, and longer-term outcomes must show an advantage over DSEK with respect to vision, endothelial cell loss, and graft survival. DMEK also has a high rate of primary (iatrogenic) graft failure, and additional donor tissue wastage occurs when preparation of DMEK grafts is unsuccessful. This review discusses endothelial keratoplasty techniques and the associated endothelial outcomes.

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Deep Lamellar Endothelial Keratoplasty

Cited by 19 publications

References 36 publications

Outcomes of Repeat Endothelial Keratoplasty in Patients With Failed Descemet Stripping Endothelial Keratoplasty

Outcomes of Repeat Endothelial Keratoplasty in Patients With Failed Descemet Stripping Endothelial Keratoplasty

Femtosecond Laser-Assisted Deep Lamellar Endothelial Keratoplasty

Graft survival and endothelial outcomes in the new era of endothelial keratoplasty

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