Simple, Inexpensive, and Effective Injector for Descemet Membrane Endothelial Keratoplasty

Kim, Eun Chul; Bonfadini, Gustavo; Todd, Leisha; Zhu, Angela Y.; Jun, Albert S.

doi:10.1097/ico.0000000000000121

Cited by 25 publications

(13 citation statements)

References 14 publications

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“…The glass Jones tube is already approved by the Food and Drug Administration for human use, and the modification in the shape allows an off-label use of this device, similar to the use of IOL injectors modified for use as DMEK tissue inserters. 4,6,15 The modified Jones glass tube is most similar in shape to the Geuder device, but is shorter in length, is wider near the distal tip, and more easily allows loading of tissue from the distal tip rather than back-end loading. Although back-loading the Melles or Geuder devices may be safer for those devices than loading through their narrower tip, we have found in our laboratory that loading the Straiko inserter through the wider distal tip is just as easy as back-loading the other glass injectors.…”

Section: Discussionmentioning

confidence: 99%

Standardized DMEK Technique

Terry

Straiko

Veldman

et al. 2015

Cornea

164

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Tissue prestripped by an eye bank technician can be safely used for DMEK surgery. SF6 gas for prolonged tissue support may reduce the rebubble rate in DMEK, with no apparent acute toxic effect. An unrecognized upside-down graft was the primary cause of graft failure in this series. Upside-down grafts may be eliminated by the use of donor tissue premarked by the eye bank with an S orientation stamp.

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Section: Discussionmentioning

confidence: 99%

Standardized DMEK Technique

Terry

Straiko

Veldman

et al. 2015

Cornea

164

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“…It has long been debated whether glass shooters might be better than shooters for cataract surgery. Currently, many surgeons use a cataract shooter for the implantation of the graft (Kim et al 2014). In our opinion, the use of validated glass injectors retains more advantages compared to plastic intraocular-lens-inserting devices.…”

Section: Discussionmentioning

confidence: 99%

“…The graft typically presents the endothelial cells outwards, so that the correct implantation in the anterior chamber can avoid unnecessary intraocular manoeuvres. Different types of implantation systems have been described, some of which are now commercially available (Arnalich-Montiel et al 2014;Kim et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Impact of the radius of the injector system on the cell viability in descemet membrane endothelial keratoplasty: an ex vivo experimental study

Yoeruek

Bartz-Schmidt

Hofmann

2015

Acta Ophthalmologica

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ABSTRACT.Purpose: To evaluate the impact of the radius of the injector system on the viability of the endothelial cells in Descemet membrane endothelial keratoplasty (DMEK). Methods: Descemet membranes (DMs) of 30 corneoscleral rims were used in a paired design and divided into three groups (A, B, C). The right corneas were used as control (without shooting through the injector after DM preparation) and the left cornea for simulation of the implantation step (shooting through a glass injector of different radii). The injector in Group A had a diameter of 0.5 mm, group B 0.9 mm and group C 1.4 mm. Prior to preparation, endothelial cell count was measured and endothelial cell quality assessed. Quantification of potential damage was achieved by staining with a viability bioassay (calcein acetoxymethyl and ethidium homodimer-1) and DAPI. Apoptosis was evaluated by TUNEL (terminal dUTP nick-end labelling) staining. Results: The average percentage of the endothelial cell death ratios was 4.9 AE 3.3% in group A (n = 5), 3.7 AE 3.7% in group B (n = 5) and 3.9 AE 3.6% in group C (n = 5) with no significant difference compared to the control. The average percentage of apoptotic endothelial cells was 0.05 AE 0.05%, 0.60 AE 0.53% and 0.15 AE 0.26% in groups A, B and C, respectively, with no significant difference compared to the control. Conclusions: Prepared grafts for transplantation in DMEK procedures may be injected through a smaller sized injector system of up to 0.5 mm with no significant increase in cell loss. Clinical studies are necessary to draw a final conclusion.

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“…The donor tissue was implanted by a 2, 8 mm clear corneal incision, using a modified intraocular lens (IOL) injector [7]. The insertion in the AC was performed slowly and the graft was opened and centered with no-touch technique maneuvers [8].…”

Section: Preparing Recipient Eye and Inserting The Graftmentioning

confidence: 99%

Untitled

2018

JOCR

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Purpose:To describe the learning curve of pre-descemet endothelial keratoplasty (PDEK) and the intraoperatory findings of the first 5 cases performed at Federal University of Sao Paulo.Methods: Five PDEK procedures were performed by the same surgeons; four cases used pneumodissection and one case used reverse hydro-bubble technique to obtain the donor graft. All cases were recorded and the following intraoperative variables were measured: type of bubble obtained, button size used and time of opening and centralization of the graft in the recipient anterior chamber.Results: Type-1 Big Bubble (BB) was achieved in three of the four cases that air dissection was used. In the fourth case of pneumodissection, there was simultaneous formation of type-1 and type-2 BB. When balanced saline solution was used for dissection, type-2 BB was obtained. Every time type-2 BB was formed, the procedure was then converted to Descemet Membrane Endothelial Keratoplasty (DMEK). When only type-1 BB was achieved, the PDEK was uneventful with an easier, manipulation of the tissue and a quicker opening in the recipient anterior chamber. Namely, grafts that included pre-Descemet's layer were less elastic and less curled. The graft size used varied from 7.50 to 7.75mm. Conclusion:PDEK is a recent technique of endothelial keratoplasty. Early outcomes suggest potential advantages in the learning curve over the prior procedures, especially by the facilitated manipulation of PDEK graft in the anterior chamber. Although results with this technique seem promising, the potential advantages need to be confirmed with long-term postoperative follow-up.

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Simple, Inexpensive, and Effective Injector for Descemet Membrane Endothelial Keratoplasty

Abstract: This simple, inexpensive, and effective injector is a safe and viable device to facilitate this part of DMEK surgery.

Cited by 25 publications

References 14 publications

Standardized DMEK Technique

Standardized DMEK Technique

Impact of the radius of the injector system on the cell viability in descemet membrane endothelial keratoplasty: an ex vivo experimental study

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