Descemet membrane endothelial keratoplasty

Ang, Marcus; Wilkins, Mark R; Mehta, Jodhbir S.; Tan, Donald

doi:10.1136/bjophthalmol-2015-306837

Cited by 128 publications

(86 citation statements)

References 84 publications

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“…6 For a decision on the need for rebubbling, further studies are required, which compare early versus late intervention and rebubbling using air versus long-acting gas. 5 In our study, we found no correlation between the preoperative parameters, donor age, sex, indication for DMEK, approach, combined procedure, graft diameter, preoperative endothelial cell density and preoperative visual acuity, and the rate of graft detachment and the rate of rebubbling (P . 0.05).…”

Section: Discussioncontrasting

confidence: 61%

“…[6][7][8][9][17][18][19] Reported rebubbling rates, however, differ vastly (3.0%-73.8%) presumably because of the different treatment regimens. 5,6,17,19,20 Some surgeons prefer early intervention in case of graft detachment, whereas others choose to intervene later. [5][6][7]13,17,21,22 Additionally, some surgeons use long-acting gas (mostly 20% SF 6 ) instead of air.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,17,19,20 Some surgeons prefer early intervention in case of graft detachment, whereas others choose to intervene later. [5][6][7]13,17,21,22 Additionally, some surgeons use long-acting gas (mostly 20% SF 6 ) instead of air. 23 In our study, an early intervention with an air bubble was performed only in cases of larger graft detachments with corneal edema in more than 2 clock hours, which resulted in a rebubbling rate of 33.3%.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, air-filling time and air-filling amount of the anterior chamber after 1 hour may be important factors for graft detachment. 5,8 In our study, however, we examined only patients with a complete air-filling time of the anterior chamber of 1 hour, which was reduced to 50% thereafter. Although this approach is very common, 7,21,27,28 it limits the interpretation of our findings.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Rebubbling, an additional intracameral air injection to fix graft detachment, is the most frequently required postoperative intervention. 5 The rate of graft detachment in DSEK is low, whereas it is higher in DMEK (10%-63%). [1][2][3][4][6][7][8][9] Although the treatment regimen of graft detachment after DMEK varies among surgeons, the higher rate of graft detachment and the consequent higher intervention rate postoperatively could be considered as disadvantages of DMEK surgery compared with DSEK surgery.…”

mentioning

confidence: 96%

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Rate and Localization of Graft Detachment in Descemet Membrane Endothelial Keratoplasty

Maier

Gundlach

Pilger

et al. 2016

Cornea

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The graft detachment rate is high after Descemet membrane endothelial keratoplasty, but detachment is usually peripheral, partial and mainly inferior and involves only a few clock hours. Only higher age of the patient is strongly associated with a higher rate of graft detachment. The incision approach is not significantly correlated with the localization of graft detachment. Therefore, the postoperative supine position of the patient seems to be of major importance.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02020044.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 96%

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Rate and Localization of Graft Detachment in Descemet Membrane Endothelial Keratoplasty

Maier

Gundlach

Pilger

et al. 2016

Cornea

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Association of the Gutta-Induced Microenvironment With Corneal Endothelial Cell Behavior and Demise in Fuchs Endothelial Corneal Dystrophy

et al. 2018

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IMPORTANCEThe number and size of guttae increase over time in Fuchs endothelial corneal dystrophy (FECD); however, the association between these physical parameters and disease pathogenesis is unclear.OBJECTIVE To determine the role of guttae in corneal endothelial cell function. DESIGN, SETTINGS, AND PARTICIPANTSIn an in vitro model, cells from a human corneal endothelial cell line, HCENC-21T, were seeded on decellularized normal (n = 30) and FECD (n = 70) endothelial basement (Descemet) membranes (DMs). Normal human corneas were sent to our laboratory from 3 sources. The study took place at the Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, and was performed from September 2015 to July 2017. Normal DMs were obtained from 3 different tissue banks and FECD-DMs were obtained from patients undergoing endothelial keratoplasty in 2 departments. MAIN OUTCOMES AND MEASURES Endothelial cell shape, growth, and migration were assessed by live-cell imaging, and gene expression analysis as a function of guttae diameter was assessed by laser capture microscopy. RESULTS Mean (SD) age of normal-DMs donors was 65.6 (4.4) years (16 women [53%]), and mean (SD) age of FECD-DMs donors was 68.9 (10.6) years (43 women [61%]). Cells covered a greater area (mean [SD], 97.7% [8.5%]) with a greater mean (SD) number of cells (2083 [153] cells/mm 2 ) on the normal DMs compared with the FECD DMs (72.8% [11%]; P = .02 and 1541[221] cells/mm 2 221/mm 2 ; P = .01, respectively). Differences in endothelial cell growth over guttae were observed on FECD DMs depending on the guttae diameter. Guttae with a mean (SD) diameter of 10.5 (2.9) μm did not impede cell growth, whereas those with a diameter of 21.1 (4.9) μm were covered only by the cell cytoplasm. Guttae with the largest mean (SD) diameter, 31.8 (3.8) μm, were not covered by cells, which instead surrounded them in a rosette pattern. Moreover, cells adjacent to large guttae upregulated αSMA, N-cadherin, Snail1, and NOX4 genes compared with ones grown on normal DMs or small guttae. Furthermore, large guttae induced TUNEL-positive apoptosis in a rosette pattern, similar to ex vivo FECD specimens.CONCLUSIONS AND RELEVANCE These findings highlight the important role of guttae in endothelial cell growth, migration, and survival. These data suggest that cell therapy procedures in FECD might be guided by the diameter of the host guttae if subsequent clinical studies confirm these laboratory findings.

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