Hybrid Technique of Lamellar Keratoplasty (DMEK-S)

Abstract

Purpose: To evaluate the outcomes of the hybrid technique of posterior lamellar keratoplasty (DMEK-S). Materials and Methods: 71 eyes of 55 patients enrolled in a single-center study underwent posterior lamellar keratoplasty with a hybrid lamella DMEK-S implanted using a solution implantation technique, owing to endothelial dysfunction. The outcome measures studied were visual acuity and endothelial cell density. Results: The rate of endothelial cell loss caused by surgery was 43.8%. During followups, we observed the stabilization of postoperative findings, or at minimum a very low rate of corneal endothelial cell loss. The UCDVA and BCDVA dramatically improved postoperatively. The rebubbling rate in our group of patients was 61.9%. We replaced the lamella due to its failure or malfunction in 17 patients (23.9%). Conclusion: In summary, DMEK-S combines the advantages of DSEK/DSAEK and DMEK. The central zone of bare Descemet's membrane and endothelium allows for very good visual outcomes, and the peripheral rim allows for better manipulation of the lamella during implantation. It is an effective method of treating the endothelial dysfunction of various etiologies, but the high complication rate needs to be addressed before widespread implementation of the technique in the future.

Eye Bank–Prepared Femtosecond Laser–Assisted Automated Descemet Membrane Endothelial Grafts

“…Studeny et al 19 reported a high rebubble rate of 61.9% in their DMEK-S series and attributed this to retained viscoelastic in the interface and a nonsmooth transition between the peripheral stromal ring and DM. In our method here, no viscoelastic was used on the anterior side of DM, and the lamellar ring is much more uniform as it was custom-cut with an FL.…”

“…First, they are difficult manual techniques and have been described elsewhere. 13,18,19 Methods to streamline the preparation of DMAEK may make it more available to surgeons. This novel approach offers a precise and predictable means in creating the stromal rim and in controlling big bubble expansion using an FL.…”

“…However, our numbers were not incongruent with previously reported manually prepared DMEK-S ECL. 19 An important limitation in our analysis is that, due to the physically different appearances of the graft, it was not possible to mask the readers. Nonmasked analysis could introduce biases into our outcomes, although the segmentation algorithm in FIJI is partially automated.…”

“…14 However, the rate at which surgeons are adopting this selective endothelial transplantation technique may be slower than previous DSEK adoption rates, likely due to the challenging and unfamiliar nature of transplanting these thin delicate grafts. [15][16][17] A hybrid technique referred to as Descemet membrane automated endothelial keratoplasty 13 (DMAEK) or Descemet membrane automated endothelial keratoplasty-stroma (DMEK-S) 18,19 is an appealing alternative to the experienced DSEK surgeon. These grafts are bare DM and endothelium centrally but are supported peripherally by a thin ring of stroma.…”

“…The above-mentioned techniques 13,18,19 of creating a DMAEK graft used manual methods that may involve significant manipulation of the tissue. In this report, we describe a novel technique using a femtosecond laser (FL) in an eye bank setting to prepare FL DMAEK grafts (fDMAEK) and explore the resultant level of endothelial damage from these eye bank manipulations.…”