Graft profile and thickness as a function of cut transition speed in Descemet-stripping automated endothelial keratoplasty

Bhogal, Maninder; Allan, Bruce

doi:10.1016/j.jcrs.2011.09.046

Cited by 18 publications

(11 citation statements)

References 23 publications

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“…Our technique of using a 400 μm microkeratome head does not have a learning curve for surgeons who are already using an artificial AC for preparation of a DSAEK donor lenticule. It has been shown previously that a slow microkeratome pass speed produced significantly thinner donor lenticules than the standard pass speed . Furthermore, our technique is more economical as compared with the double pass technique and bereft of the possible complications associated with the double pass technique.…”

Section: Discussionmentioning

confidence: 72%

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Thin lenticule Descemet's stripping automated endothelial keratoplasty: single, slow pass technique

Vajpayee

Maharana

Jain

et al. 2013

Clinical Exper Ophthalmology

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Section: Discussionmentioning

confidence: 72%

“…It has been shown previously that a slow microkeratome pass speed produced significantly thinner donor lenticules than the standard pass speed. 12 Furthermore, our technique is more economical as compared with the double pass technique and bereft of the possible complications associated with the double pass technique.…”

Section: Discussionmentioning

confidence: 94%

Thin lenticule Descemet's stripping automated endothelial keratoplasty: single, slow pass technique

Vajpayee

Maharana

Jain

et al. 2013

Clinical Exper Ophthalmology

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“…Control of the IP in microkeratome cutting has not been standardized, and various methods have been used including adjusting hydrostatic pressure by elevating a balanced salt solution bottle, 10 , 11 , 19 inflating with air from a syringe, 2 , 3 , 7 , 8 , 19 and ocular tonometry measuring a tonometer. 13 , 20 , 21 We found that IP control using the conventional method produced high variation in IP level during cutting, and the peak IP levels varied among cuts ( Figs. 1A and 1C ).…”

Section: Discussionmentioning

confidence: 87%

Comparison of Artificial Anterior Chamber Internal Pressures and Cutting Systems for Descemet's Stripping Automated Endothelial Keratoplasty

Nishisako

Aoki

Sasaki

et al. 2018

Trans. Vis. Sci. Tech.

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PurposeTo optimize methods of preparing donor cornea tissue for Descemet's stripping automated endothelial keratoplasty (DSAEK), we compared five experimental conditions with different internal pressures and cutting systems.MethodsThe artificial anterior chamber internal pressure (IP) was set at 100 or 200 mm Hg. The microkeratome cut was performed with or without an artificial chamber pressurizer (ACP), using a CBm turbine (CBm) or one use-plus automated (OUP-A). Thirty human research corneas were divided into five groups, and compared after the cut with donor tissue quality parameters, including cutting depth, graft uniformity, cell evaluation, and smoothness of the stromal surface.ResultsThe smallest variation in mean cut depth was observed in the condition, which had IP of 200 mm Hg used ACP and OUP-A. In experimental groups cut using CBm, significantly more consistent thicknesses were made at an IP of 200 than 100 mm Hg. There were no statistically significant differences among the groups in either endothelial cell density or cell viable assay results after cuts. Using an IP of 200 mm Hg with ACP and CBm produced the roughest stromal surface, and the roughness grading scores showed a positive correlation with the percentage of cut depth.ConclusionsAn IP of 200 mm Hg was the best setting for DSAEK grafts with high predictability of cut depth and uniformity of graft thickness without endothelial cell damage.Translational RelevanceFor successful DSAEK, it is recommended that a set internal pressure of 200 mm Hg be used during microkeratome cutting for donor tissue preparation.

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“…23 A recent report shows that alteration in the posterior astigmatism at least in part may be intrinsic to microkeratome donor preparation. 24 …”

Section: Discussionmentioning

confidence: 99%

Optimization of Intraocular Lens Constant Improves Refractive Outcomes in Combined Endothelial Keratoplasty and Cataract Surgery

Bonfadini

Ladas²,

Moreira³

et al. 2013

Ophthalmology

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Purpose To evaluate the accuracy of intraocular lens (IOL) power calculations with A-constant optimization in Descemet’s stripping automated endothelial keratoplasty (DSAEK) combined with cataract extraction and intraocular lens implantation (DSAEK triple procedure). Design Retrospective case series. Participants Thirty eyes of 22 patients with Fuchs’ endothelial dystrophy who underwent the DSAEK triple procedure performed by a single surgeon. Methods Prediction errors were calculated retrospectively for consecutive DSAEK triple procedures. These prediction errors then were used to determine an IOL constant for this cohort of patients. The new optimized IOL constant subsequently was compared with the manufacturer’s IOL constant, allowing evaluation and quantification of refractive benefits of optimization. Main Outcomes Measures The error in diopters (D) of the predicted refraction with the manufacturer’s and optimized IOL constants. Results Optimization of the A constant decreased the mean absolute error (MAE) from 1.09±0.63 D (range, 0.12–2.41 D) to 0.61±0.4 D (range, 0–1.58 D; P = 0.004). Comparing the intended and final postoperative refractions calculated with the original manufacturer’s constant and the optimized constant, 20% versus 43% of all eyes were in the less than 0.5-D range and 50% versus 83% of all eyes were in the less than 1.0-D range of the target refraction. Furthermore, optimization decreased the number of eyes that were more than 1.0 D from the target refraction from 50% to 17%. Conclusions Optimization of the IOL constant showed significantly improved accuracy of predicted postoperative refraction compared with the manufacturer’s IOL constant, which may help improve the postoperative refractive outcomes in patients undergoing the DSAEK triple procedure.

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Graft profile and thickness as a function of cut transition speed in Descemet-stripping automated endothelial keratoplasty

Abstract: Reducing the transition speed in microkeratome dissection produced thinner donor lenticules. Thickness asymmetry is an inherent flaw with current microkeratome dissection that cannot be easily corrected by altering preparation technique.

Cited by 18 publications

References 23 publications

Thin lenticule Descemet's stripping automated endothelial keratoplasty: single, slow pass technique

Thin lenticule Descemet's stripping automated endothelial keratoplasty: single, slow pass technique

Comparison of Artificial Anterior Chamber Internal Pressures and Cutting Systems for Descemet's Stripping Automated Endothelial Keratoplasty

Optimization of Intraocular Lens Constant Improves Refractive Outcomes in Combined Endothelial Keratoplasty and Cataract Surgery

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