Learning Curve in Descemet's Membrane Endothelial Keratoplasty

Dapena, Isabel; Ham, Lisanne; Droutsas, Konstantinos; Dijk, Korine van; Moutsouris, Kyros; Melles, Gerrit R.J.

doi:10.1016/j.ophtha.2011.03.037

Cited by 238 publications

(265 citation statements)

References 32 publications

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“…Additionally, Guell et al found no difference in endothelial cell counts between use of SF 6 or air ≤3years after DMEK (9) . One weakness of our study was that the SF 6 procedures followed the air procedures chronologically because detachment rates have been found to diminish with experience of the surgeon (15) . However, the reduction in detachment rates from the first 21 to the next 21 consecutive eyes was dramatic, and detachment rates were equivalent between those in the first half of air cases and those in the second half.…”

Section: Discussionmentioning

confidence: 97%

Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK)

Botsford¹,

Vedana²,

Cope³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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Purpose: To compare the effect of 20% sulfur hexafluoride (SF 6 ) with that of air on graft detachment rates for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK). Methods: Forty-two eyes of patients who underwent DMEK by a single surgeon (A.S.J.) at Wilmer Eye Institute between January 2012 and 2014 were identified; 21 received air for intraocular tamponade and the next consecutive 21 received SF 6 . The main outcome measure was the graft detachment rate; univariate and multivariate analyses were performed. Results: The graft detachment rate was 67% in the air group and 19% in the SF 6 group (p<0.05). No complete graft detachments occurred, and all partial detachments underwent intervention with injection of intraocular air. The percentages of eyes with 20/25 or better vision were not different between the groups (67% vs. 71%). Univariate analysis showed significantly higher detachment rates with air tamponade (OR, 8.50; p<0.005) and larger donor graft size (OR, 14.96; p<0.05). Multivariate analysis with gas but not graft size included showed that gas was an independent statistically significant predictor of outcome (OR, 6.65; p<0.05). When graft size was included as a covariate, gas was no longer a statistically significant predictor of detachment but maintained OR of 7.81 (p=0.063) similar to the results of univariate and multivariate analyses without graft size. Conclusion:In comparison with air, graft detachment rates for intraocular tamponade in DMEK were significantly reduced by 20% SF 6 .

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Section: Discussionmentioning

confidence: 97%

Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK)

Botsford¹,

Vedana²,

Cope³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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“…No viscoelastic agent is needed and the glass surfaces are much smoother and can be manufactured without sharp molding edges. 1 A drawback of the Pasteur glass pipette is that the small exit port is also the entry port, so the roll needs to be compressed to enter the pipette, with evident friction trauma. The custom-made glass injector of Melles does have a large entry in one end to reduce friction and a small exit in the other end to reduce the size of the incision, but it needs to be disassembled from the syringe when changing from aspirating to injecting the roll, complicating the maneuver.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although endothelial cell loss may be higher during the learning curve, 2 larger series of cases 3,4 have reported similar results as DSAEK (Descemet Stripping Automated Endothelial Keratoplasty).…”

Section: Introductionmentioning

confidence: 90%

Double port injector device to reduce endothelial damage in DMEK

Arnalich‐Montiel

Muñoz‐Negrete

Miguel

2014

Eye

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Objective To study endothelial injury from a newly designed asymmetric double port Descemet Membrane Endothelial Keratoplasty (DMEK) injector, both ex-vivo and in clinical practice. Design Laboratory investigation with an interventional case series study. Method Sixteen rabbit endothelial rolls were tested for injection using a no-touch technique. For each pair of rolls, one endothelial graft underwent injection with a single port Pasteur pipette twice, wheras the other was injected with a novel asymmetric double port injector with a larger diameter entry port than the exit port also twice. Each graft was stained with 4-6-diamidino-2-phenylinidole dihydrochloride and was counted under a fluorescence-inverted microscope before and after injection. The proportion of graft injury was calculated and the differences were analyzed. Subsequently, six patients requiring DMEK underwent surgery using this novel insertion device and endothelial cell loss was calculated 3 months after the surgery. Results After injection, the mean proportion of endothelial cell survival with the single port pipette was 78.8% (n ¼ 8; SD: ± 20.9%), whereas the double port injector yielded a survival rate of 96.8% (n ¼ 8; SD: ±8.4%). This difference was statistically significant (P ¼ 0.008), representing less endothelial injury with the double port device. Early endothelial cell loss after 3 months in the DMEK patients was 26.1% (SD: ± 6.1%). Conclusion In our injection model, using a double port injector created significantly less endothelial cell damage than with the single port pipette. Clinically, this device yielded early endothelial cell loss comparable to that of the series performed by experienced DMEK surgeons.

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“…11,[49][50][51] Similarly, detachment rates of 20-60 % have been reported after DMEK, although many of these cases do not appear to be clinically significant. 22,35,[52][53][54] Frequently, DMEK detachments are small, peripheral, and temporary. And even when the detached areas are both large and central, some patients nevertheless achieve BCVAs ≥20/40.…”

Section: Complications Graftmentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty—A Review

Parker¹,

Parker²,

Melles³

2013

US Ophthalmic Review

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Descemet membrane endothelial keratoplasty (DMEK) is the most recent step forward in the evolution of endothelial keratoplasty toward thinner grafts and more natural, anatomic corneal restoration. Offering unprecedented visual results and requiring no special or expensive equipment, DMEK has the potential to become the first line treatment for corneal endothelial disorders. The surgery's perceived shortcomings (primarily technical difficulty) have mostly been addressed by new 'no-touch' procedures for both graft preparation and graft unfolding in the recipient eye. And as a result, DMEK has been gaining traction with ophthalmologists the world over. Now, in its most recent formulation, DMEK is ready for the typical corneal surgeon, in any clinical setting, and at low cost.

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Learning Curve in Descemet's Membrane Endothelial Keratoplasty

Cited by 238 publications

References 32 publications

Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK)

Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK)

Double port injector device to reduce endothelial damage in DMEK

Descemet Membrane Endothelial Keratoplasty—A Review

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