Endothelial Keratoplasty Safety-Basket Suture for Management of Difficult Cases

Behshad, Soroosh; Jacobsen, Bradley H.; Pinney, Elizabeth L.; Wade, Mathew; Garg, Sumit

doi:10.1097/ico.0000000000000839

Cited by 11 publications

(18 citation statements)

References 3 publications

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“…There are some reports in the literature describing suture placement techniques to improve graft adherence in Descemet stripping automated endothelial keratoplasty (DSAEK) on failed PK. 7,8 However, to our knowledge, our case is the first report of a patient with successfully sutured DMEK to a failed PK. Our technique involved placing three radial interrupted full thickness 10-0 nylon sutures into the inferior cornea along with an intracameral injection of air.…”

Section: Discussionmentioning

confidence: 72%

“…In order to prevent recurrent Descemet detachment in eyes undergoing EK with high risk of graft detachment, some suturing techniques are described in the literature like safety-basket or cloverleaf retention suture. 7 , 8 They act like a scaffolding under the graft and provide extra support. However, these techniques are utilised in DSAEK but not DMEK.…”

Section: Discussionmentioning

confidence: 99%

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Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021

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A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021

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“…8 In 2013, Masket and Fram 9 described a “safety-basket” technique in which a 10-0 polypropylene suture is placed in a similar square “tic-tac-toe” pattern through the pars plana to centralize and stabilize the optic of an intraoperative lens as an aid to scleral fixation during either secondary intraocular lens implantation or revision surgery for intraocular lens dislocation. Behshad et al,5 and later Newman and Rosenwasser,7 adapted this approach to help prevent postoperative posterior dislocation of the donor in DSAEK.…”

Section: Discussionmentioning

confidence: 99%

Safety-Net Suture for Aphakic Descemet Membrane Endothelial Keratoplasty

Berger

Kriman

Vasquez-Perez

et al. 2022

Cornea

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Purpose:The purpose of this research was to describe a low-cost, accessible method for reducing the risk of posterior donor dislocation in Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with aphakia and a large iris defect (unicameral eyes)—the “safety-net suture.”Methods:We review 3 cases of aphakic bullous keratopathy in unicameral eyes treated successfully using DMEK aided by a simple technique to create a temporary, partial barrier between the anterior and posterior chambers. The safety-net suture technique is based on a continuous 10-0 polypropylene suture placed across the anterior chamber in a cat's-cradle pattern anterior to the trabecular meshwork. At the end of surgery, after air tamponade of the DMEK donor, the 10-0 polypropylene suture is removed.Results:All 3 cases were completed with no intraoperative posterior dislocation. A partial postoperative detachment in 1 case was successfully treated with repeat air tamponade. The corneas remain clear in early follow-up, 1 to 10 months after surgery.Conclusions:The safety-net suture is a simple, low-cost method of reducing the risk of intraoperative posterior dislocation for DMEK in unicameral, aphakic eyes.

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“…One of the drawbacks of the Busin glide is anterior chamber collapse during donor lenticule insertion. 16 The other suture techniques used for preventing intraoperative and postoperative graft dislocation into the vitreous cavity in such eyes were a graft retention sutures under the graft, such as the “safety-basket suture,” 17 “cloverleaf or parallel suture,” 18 or “wheel spokes suture.” 19 However, such suturing techniques may be complicated and could be time-consuming. In our technique, we did not use any anchoring suture in all cases.…”

Section: Discussionmentioning

confidence: 99%

“Air-Assisted” Donor Lenticule Insertion in Descemet Stripping Endothelial Keratoplasty in Aphakia With Large Iris Defect and Without Posterior Capsular Support

Basak

2022

Cornea

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The purpose of this study was to report a novel technique of donor lenticule insertion in Descemet stripping endothelial keratoplasty (DSEK) in aphakic corneal edema with large iris defect and without any posterior capsular support.Methods: This was a retrospective consecutive interventional case series. Clinical records of ten 1-eyed aphakic patients with corneal edema with large iris defect and no capsular support who underwent air-assisted donor lenticule insertion in DSEK were evaluated. After making 6.0-to 6.5-mm sclerocorneal tunnel and 2 side ports, limited anterior vitrectomy was performed if required. Then, Descemetorhexis was performed under air through side ports. Manually dissected donor lenticule was inserted into the anterior chamber under full-chamber air by a 30-G needle push-in technique. Further air tamponade was given if necessary. No fluid-air exchange was performed. The patient was kept on the same operating table for at least 1 hour and then shifted. Graft attachments in early postoperative period, corrected distant visual acuity, and endothelial cell density after 3, 6, and 12 months were analyzed. Results:The mean postoperative follow-up period was 19.2 6 6.7 months. There was no donor dislocation in this small group. All patients achieved a corrected distant visual acuity of 0.70 (20/100) after 3 months and maintained until 12 months. The endothelial cell density at 3 months (n = 8) was 2028 6 151/mm 2 , at 6 months (n = 7) 1776 6 198/mm 2 , and at 12 months (n = 7) 1721 6 172/mm 2 . The corresponding endothelial cell loss was 25.8% 6 5.6%, 34.4% 6 5.1%, and 37.8% 6 7.1%, respectively. One graft failed after 15 months.Conclusions: "Air-assisted" donor lenticule insertion in DSEK is a safe surgical technique in aphakic patients with corneal edema with large iris defect and no capsular support.

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Endothelial Keratoplasty Safety-Basket Suture for Management of Difficult Cases

Cited by 11 publications

References 3 publications

Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

Safety-Net Suture for Aphakic Descemet Membrane Endothelial Keratoplasty

“Air-Assisted” Donor Lenticule Insertion in Descemet Stripping Endothelial Keratoplasty in Aphakia With Large Iris Defect and Without Posterior Capsular Support

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