Preliminary clinical results of posterior lamellar keratoplasty through a sclerocorneal pocket incision11The authors have no proprietary interest in the materials presented.

Melles, Gerrit R.J.; Lander, Frank; Dooren, Bart T. H. van; Pels, Elisabeth; Beekhuis, W. H.

doi:10.1016/s0161-6420(00)00253-0

Cited by 202 publications

(111 citation statements)

References 33 publications

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“…[1][2][3][4][5][6] These techniques have been popularised in the United States as 'deep lamellar endothelial keratoplasty' (DLEK), 7,8 and (femtosecond) Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK/FS-DSEK). [9][10][11][12] In 1998, we also described a technique for selective transplantation of Descemet membrane through a self-sealing 3.5 mm clear corneal incision, 13,14 tentatively named Descemet membrane endothelial keratoplasty (DMEK).…”

Section: Introductionmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Ham

Dapena

Luijk

et al. 2009

Eye

213

142

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Purpose: To evaluate the clinical outcome and complications of Descemet membrane endothelial keratoplasty (DMEK), using Descemet-stripping endothelial keratoplasty (DSEK) as a back-up procedure, in the management of Fuchs endothelial dystrophy. Design: Non-randomised prospective clinical study. Methods: The first fifty consecutive eyes that underwent DMEK, that is, transplantation of an isolated donor Descemet membrane carrying its endothelium, for Fuchs endothelial dystrophy were evaluated. In all eyes, the best-corrected visual acuity (BCVA) as well as the endothelial cell density (ECD) was measured before and at 6 months after surgery, as clinical outcome parameters. Results: Ten patients required a secondary DSEK for failed DMEK. In the remaining 40 DMEK eyes, 95% had a BCVA of X20/40 (X0.5) and 75% X20/25 (X0.8) at 6 months after surgery. ECD averaged 2618 ( ± 201) cells/mm 2 before, and 1876 ( ± 522) cells/mm 2 at 6 months after surgery (n ¼ 35). When the outcomes of DMEK and secondary DSEK procedures were combined, 94% reached a BCVA of X20/40 (X0.5) and 66% X20/25 (X0.8) (n ¼ 47), and ECD averaged 2623 ( ± 193) cells/mm 2 before, and 1815 ( ± 578) cells/mm 2 at 6 months after surgery (n ¼ 43). Conclusion: With DSEK as a back-up procedure, DMEK may provide relatively quick and complete visual rehabilitation in a majority of patients operated on for Fuchs endothelial dystrophy. Endothelial cell survival may be similar to earlier types of (lamellar) keratoplasty. Early graft detachment was the main complication in this first series of DMEK surgeries for Fuchs endothelial dystrophy.

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Section: Introductionmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Ham

Dapena

Luijk

et al. 2009

Eye

213

142

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“…33 Only recently have the techniques of LK been applied to the replacement of the posterior tissue and the endothelium. [23][24][25][26][27][28][29][30][31] One lamellar technique for endothelial replacement involves the creation of a surface corneal flap with a microkeratome, followed by trephination of the recipient posterior tissue and replacement with a posterior donor button. In this technique, the donor tissue is either sutured into place and/or oversized, and the surface 'Lasik style' corneal flap is sutured down into position.…”

Section: Lamellar Surgery For Endothelial Replacementmentioning

confidence: 99%

“…His first series of patients with long-term follow-up was reported in 2000. 29 In 1999, Mark Terry and Paula Ousley of the United States began laboratory investigation of the PLK procedure, and after modification of the technique and instrumentation, they termed the procedure 'deep lamellar endothelial keratroplasty' (DLEK). They published their laboratory data in 2001 and the results from their first two clinical patients that same year.…”

Section: Lamellar Surgery For Endothelial Replacementmentioning

confidence: 99%

“…51,52 After endothelial replacement through PLK surgery, Melles has reported an average cell count of 25207340 cells/mm 2 and Terry reported similar results at 6 months for his initial series. 29,30 The last consecutive 21 patients in Terry's DLEK study have an average endothelial cell density of 21937456 at 6 months (n ¼ 21) and 22317573 at 1 year (n ¼ 15). This represents only an average 19% cell loss from pre-operative cell counts and compares favourably with the 34722% cell loss sustained by the PK patients at 1 year postoperatively reported by Ing and Bourne.…”

Section: Healthy Donor Endotheliummentioning

confidence: 99%

“…Recent advances in posterior lamellar surgery have allowed for the replacement of the endothelium while leaving the surface of the cornea untouched. [23][24][25][26][27][28][29][30][31] Results with this innovative technique are encouraging and promise a new level of expectations for success by the corneal transplant patient.…”

Section: Introductionmentioning

confidence: 99%

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Deep lamellar endothelial keratoplasty (DLEK): pursuing the ideal goals of endothelial replacement

Terry

2003

Eye

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Endothelial dysfunction is a leading cause of corneal vision loss and treatment requires surgical replacement with donor endothelium. Standard penetrating keratoplasty (PK) suffers from the inherent problems of surface corneal incisions and sutures and poor wound healing of vertical stromal wounds. This often results in high irregular astigmatism, unpredictable corneal power, and the risk of long-term visual loss from suture-induced vascularization, ulceration, rejection, and late wound rupture. This paper delineates five ideal goals of endothelial replacement, which include: (1) a smooth surface topography without significant change in astigmatism from preoperative to postoperative; (2) a highly predictable and stable corneal power; (3) a healthy donor endothelium that resolves all oedema; (4) a tectonically stable globe, safe from injury and infection; and (5) an optically pure cornea. Deep lamellar endothelial keratoplasty (DLEK) is a surgical method of endothelial replacement that is performed through a limbal scleral incision that leaves the surface of the recipient cornea untouched. The early results of this innovative surgery are discussed and compared to the results of PK in terms of fulfillment of the five ideal goals of endothelial replacement. With further refinement of interface creation, DLEK surgery may be the ideal method for endothelial replacement.

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A New Lamellar Wound Configuration for Penetrating Keratoplasty Surgery

Busin¹

2003

Arch Ophthalmol

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modified penetrating keratoplasty procedure with a new lamellar configuration of the surgical wound was performed on 8 eyes with endothelial decompensation. This technique allows complete suture removal by 3 months postoperatively, substantially shortening the time necessary for visual rehabilitation. Refractive astigmatism before and after suture removal was minimized to 4 diopters or less in all of the eyes in our preliminary series. Because the anterior surface of the donor button is smaller than the posterior one (diameter, 7.0 mm and 9.0 mm, respectively), more endothelial cells can be transplanted while maintaining the anterior graft surface at a safe distance from the corneoscleral limbus. Finally, no expensive instrumentation is required for this procedure except for an artificial anterior chamber if whole globes are not available. The surgical technique and clinical results are presented in this article.

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Preliminary clinical results of posterior lamellar keratoplasty through a sclerocorneal pocket incision11The authors have no proprietary interest in the materials presented.

Cited by 202 publications

References 33 publications

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases

Deep lamellar endothelial keratoplasty (DLEK): pursuing the ideal goals of endothelial replacement

A New Lamellar Wound Configuration for Penetrating Keratoplasty Surgery

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