Incidence and Clinical Course of Immune Reactions after Descemet Membrane Endothelial Keratoplasty

Hos, Deniz; Tuac, Onur; Schaub, Friederike; Stanzel, Tisha Prabriputaloong; Schrittenlocher, Silvia; Hellmich, Martin; Bachmann, Björn; Cursiefen, Claus

doi:10.1016/j.ophtha.2016.12.017

Cited by 121 publications

(103 citation statements)

References 25 publications

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“…As reported by Hos et al. (), the risk of developing an immune episode after DMEK is very low; the incidence for corneal graft rejection was 2.3% during a five‐year follow‐up. Also, changes in lipoid composition may reflect oxidative stress‐related changes in the metabolism of endothelial cells in FECD eyes (Cabrerizo et al.…”

Section: Discussionmentioning

confidence: 56%

“…This procedure allows for rapid visual recovery and fewer immunological graft rejections compared to conventional penetrating keratoplasty (Melles et al 2006;Anshu et al 2012;Steven et al 2013). Compared to Descemet's Stripping (Automated) Endothelial Keratoplasty (DS (A)EK), the advantages of DMEK include fewer higher-order optical aberrations, improved contrast sensitivity and lower rates of immune reactions (Price et al 2009;Rudolph et al 2012;Hos et al 2017). Compared to penetrating keratoplasty, the higher endothelial cell loss directly after the procedure is considered as a potential drawback of DMEK.…”

Section: Worldwidementioning

confidence: 99%

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Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Schrittenlocher

Bachmann

Cursiefen

2018

Acta Ophthalmologica

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Purpose To assess the effect of donor tissue diameter in Descemet Membrane Endothelial Keratoplasty (DMEK) on postoperative endothelial cell density (ECD) mainly in Fuchs Endothelial Corneal Dystrophy (FECD) patients. Methods Retrospective review of 693 consecutive DMEK surgeries from the prospective Cologne DMEK database performed between 07/2011 and 07/2016 at the Department of Ophthalmology, University of Cologne. Eight‐ versus ten‐millimetre large donor DMEK grafts of two different surgeons using identical surgical techniques were compared. Results A total of 693 consecutive DMEK surgeries were included. Two groups (8 versus 10 mm DMEK graft diameter) were compared: 23% of eyes received 8‐mm grafts (group 1, n = 160) and 77% 10‐mm grafts (group 2, n = 533). Mean preoperative ECD (±SD) of donor tissue was 2736 ± 224 cells/mm2 in group 1 and 2714 ± 232 in group 2. Group 1 showed a mean ECD of 1740 ± 439 cells/mm2 (mean ± SD; n = 67) 12 months after DMEK compared to 1664 ± 404 cells/mm2 (mean ± SD; n = 344) in group 2. The difference between the 6‐ and 12‐month ECD of both groups was not significant (p = 0.675; p = 0.161). Total decrease in ECD 6‐ and 12‐months postoperatively was 38 ± 14 (n = 128) and 36 ± 16% in group 1 (n = 66) versus 37 ± 15% (n = 398) and 38 ± 15% in group 2 (n = 342; p = 0.414; p = 0.198, respectively). Conclusion Our data suggest that postoperative central endothelial cell density is not significantly associated with DMEK graft diameters in the range of 8–10 mm in cases with healthy peripheral host endothelium (such as FECD).

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Section: Discussionmentioning

confidence: 56%

Section: Worldwidementioning

confidence: 99%

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Schrittenlocher

Bachmann

Cursiefen

2018

Acta Ophthalmologica

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“…We speculate that SKPs' ability has passed to CEC-like cells. On the other hand, the anterior-chamberassociated immune deviation (ACAID) mechanism, the less irritating surgical procedure, and the serum free medium culture of CEC-like cells were also factors that could reduce cell immunogenicity [19][20][21]. This is why CEC-like cells were stable and could adapt to the microenvironment after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Long-term observation and sequencing analysis of SKPs-derived corneal endothelial cell-like cells for treating corneal endothelial dysfunction

Shen

Sun

et al. 2020

Preprint

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Background Corneal endothelial dysfunction is a principal cause of visual deficiency. Corneal transplantation is the most effective treatment for corneal endothelial dysfunction. However, a severe shortage of available donor corneas or human corneal endothelial cells (HCEC) remains a global challenge. Previously, we acquired corneal endothelial cell-like cells (CEC-like cells) derived from human skin-derived precursors (SKPs). CEC-like cells were injected into rabbit and monkey corneal endothelial dysfunction models and exerted excellent therapeutic effect. Method We prolonged the clinical observation in the monkey experiment for 2 years. PCR and DNA sequencing were carried out to confirm the existence of CEC-like cells. Histological examinations were carried out to show the corneal morphology. Further transcriptome sequencing was also carried out on HCEC, CEC-like cells before transplantation and after transplantation. Results The monkeys cornea remained transparent and normal thickness. The total endothelial cell density decreased gradually, but tended to be stable and remained in a normal range during 2-year observation. The CEC-like cells persist during observation and could adapt to the microenvironment after transplantation. The gene expression pattern of CEC-like cells was similar to HCEC and changed slightly after transplantation. Conclusions CEC-like cells could adapt to the microenvironment and had a good therapeutic effect after being transplanted into the monkey endothelial dysfunction model during long-term observation. This study provided a promising prospect of cell-based therapy for corneal endothelial dysfunction and may be clinically applied in regenerative medicine in the future.

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“…The importance of DMEK to treat endothelial disorders is growing rapidly worldwide due to favorable outcomes over competing techniques [2, 17]. Therefore, the question of the best anterior chamber tamponade to support attachment of the DMEK lamella has been in focus in the last years [1].…”

Section: Discussionmentioning

confidence: 99%

Temporary Filtering Bleb Failure Induced by Anterior Chamber Sulfur Hexafluoride Gas: A Complication after Descemet Membrane Endothelial Keratoplasty

Enders

Avgitidou

Heindl

et al. 2019

Case Rep Ophthalmol

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Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF₆) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF₆ gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF₆ volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF₆ gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery.

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Incidence and Clinical Course of Immune Reactions after Descemet Membrane Endothelial Keratoplasty

Cited by 121 publications

References 25 publications

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Impact of donor tissue diameter on postoperative central endothelial cell density in Descemet Membrane Endothelial Keratoplasty

Long-term observation and sequencing analysis of SKPs-derived corneal endothelial cell-like cells for treating corneal endothelial dysfunction

Temporary Filtering Bleb Failure Induced by Anterior Chamber Sulfur Hexafluoride Gas: A Complication after Descemet Membrane Endothelial Keratoplasty

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