Impact of Surgical Learning Curve in Descemet Membrane Endothelial Keratoplasty on Visual Acuity Gain

Debellemanière, Guillaume; Guilbert, Emmanuel; Courtin, Romain; Panthier, Christophe; Sabatier, Patrick; Gatinel, Damien; Saad, Alain

doi:10.1097/ico.0000000000001066

Cited by 56 publications

(36 citation statements)

References 21 publications

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“…In this study we had limited information on donor characteristics that could have affected ECD. Although some evidence suggests that a systemic disease such as diabetes does not affect ECD of donor grafts, 15 this effect could be different for other diseases. We could not explore such effects and hence our interpretation is limited.…”

Section: Discussionmentioning

confidence: 99%

“…This observation is different from a study by Schaub et al 13 who noted no preparation failures. Although we were unable to access the medical history of the donor for this retrospective study to account for diabetes status of the donor, a risk factor for preparation failure, 15 we did control for complicating factors such as donor age and cultivation time. 6 16 The higher rate of preparation failure suggests that adhesions following cataract surgery may contribute to complicating the preparation of pseudophakic donor tissue.…”

Section: Discussionmentioning

confidence: 99%

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Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons

Pilger

Torun²,

Maier

et al. 2020

BMJ Open Ophth

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ObjectiveIncreasingly, cornea banks are recovering donor tissue from pseudophakic donors. Little is known about their suitability for Descemet membrane endothelial keratoplasty (DMEK) surgery in terms of endothelial cell density (ECD) and preparation failure.Methods and AnalysisWe explored ECD during donor tissue preparation in 2076 grafts. Preparation failure was analysed in 1028 grafts used in DMEK surgery at our clinic. To monitor ECD and functional results, we matched 86 DMEK patients who received pseudophakic donor grafts with similar recipients of phakic donor grafts and followed them up for 36 months.ResultsAt recovery, mean ECD in pseudophakic donor grafts was 2193 cells/mm2 (SD 28.7) and 2364 cells/mm2 (SD 15.7) in phakic donor grafts (p<0.001). After cultivation, the difference increased as pseudophakic donor grafts lost 14% of ECD while phakic lost only 6% (p<0.001). At transplantation, mean ECD in pseudophakic donor grafts was 2272 cells/mm2 (SD 250) and 2370 cells/mm2 (SD 204) in phakic donor grafts (p<0.001). After transplantation, the difference in ECD increased as pseudophakic donor grafts lost 27.7% of ECD while phakic donor grafts lost only 13.3% (p<0.001). The risk of preparation failure in pseudophakic donor grafts was higher than in phakic donor grafts (OR 4.75, 95% CI 1.78 to 12.67, p=0.02). Visual acuity increased in both groups similarly.ConclusionsPseudophakic donor grafts have a lower ECD, are more prone to endothelial cell loss during recovery and surgery and are associated with a higher risk of preparation failure. Cornea banks and surgeons should consider this in the planning of graft preparation and transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons

Pilger

Torun²,

Maier

et al. 2020

BMJ Open Ophth

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“…However, after DMEK, the ECD loss was greater than that after cataract surgery, attaining 30–54% at 6 months postoperatively [5, 6, 30, 31]. This reflected extensive cell death, potentially attributable to not only surgical stress.…”

Section: Discussionmentioning

confidence: 99%

Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty

Hayashi

Yuda

Oyakawa

et al. 2017

BioMed Research International

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Vital staining of the endothelial graft is essential during Descemet's membrane endothelial keratoplasty (DMEK) to ensure surgical success. DMEK surgeons worldwide commonly use trypan blue (TB) to this end. However, TB may exert toxic effects on both the cornea and retina. Recently, Brilliant Blue G (BBG) has become recognized as an alternative stain for use during vitreoretinal surgery; BBG is associated with lower levels of toxicity. We retrospectively analyzed the utility of BBG staining during DMEK. We used 0.1% (w/v) BBG to stain the DMEK grafts of 12 patients. We evaluated the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) before and 3 and 6 months after surgery. BBG was effective in terms of graft visualization during DMEK. The BSCVA (log MAR) improved from 0.99 ± 0.57 to 0.01 ± 0.07 (p < 0.05). The CCT decreased from 720.3 ± 58.1 μm preoperatively to 511.5 ± 50.6 μm at 6 months postoperatively (p = 0.0001). The ECD decreased from 2,754 ± 296 cells/mm2 to 1,708 ± 426 cells/mm2 at 6 months postoperatively (p < 0.001). The ECD loss was 37.9 ± 16.3%. The outcomes using BBG were comparable to those of earlier reports that employed TB; thus, BBG may be a viable alternative to TB.

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“…Световая микроскопия подтвердила отсутствие фрагментов стромального слоя роговицы в группах А, В и С. Визуализировалась лишь десцеметова мембрана с эндотелиальной выстилкой (рис. 1-3), в то нее для выполнения данного метода необходим более длительный срок подготовки хирурга [1,[18][19][20].…”

Section: результаты и обсуждениеunclassified

Comparative analysis of modern methods of preparing donor material for endothelial keratoplasty

et al. 2018

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Эндотелиальная кератопластика является операцией выбора при необходимости трансплантации роговицы у пациентов с патологией эндотелия [1, 2]. Наиболее широко распространенной модификацией считается автоматизированная эндотелиальная кератопластика, при которой микрокератомом выкраи

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Impact of Surgical Learning Curve in Descemet Membrane Endothelial Keratoplasty on Visual Acuity Gain

Abstract: Surgical experience allowed faster graft preparation and faster unrolling time in DMEK. Neither experience nor percentage cell loss influenced postoperative visual acuity gain. The number of procedures needed to reach a good standard of care was estimated to be 50 in our patient database.

Cited by 56 publications

References 21 publications

Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons

Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons

Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty

Comparative analysis of modern methods of preparing donor material for endothelial keratoplasty

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