Standardized pachymetry-assisted manual lamellar dissection for Descemet stripping endothelial keratoplasty

Abstract

Purpose: To present an alternative technique (Pachy-DSEK) for the manual preparation of thin endothelial lamellae in Descemet stripping endothelial keratoplasty (DSEK), as well as to evaluate its visual and anatomic outcomes. Methods: A retrospective chart review was conducted in 15 cases who underwent DSEK at a private eye clinic in Brazil (INOB, Brasília) from June 2017 to December 2019. All patients had ocular comorbidities and relative contraindications to Descemet membrane endothelial keratoplasty (DMEK). All endothelial lamellae were manually prepared by using a standardized technique. Best corrected visual acuity (BCVA), tomographic parameters and graft’s thickness were evaluated preoperatively and at 6 months. Endothelial cell counts were evaluated preoperatively and at 12 to 24 months. Results: During preparation there was one case (6%) of peripheral tear and no tissue was lost. At 6 months, the median BCVA improved from 1.60 to 0.40 logMAR ( p = 0.0009). There was no significant change in anterior ( p = 0.507) and posterior astigmatism ( p = 0.483), anterior ( p = 0.683) and posterior mean keratometry ( p = 0.767), and total corneal power ( p = 0.952). The median central graft thickness at 6 months was 80 µm. Ultrathin grafts (<130 µm) were achieved in 80% of cases. At 12 to 24 months endothelial cell count decreased significantly. Graft’s detachment occurred in two cases (13%) and endothelial rejection in one case (6%). Conclusion: By using ultrasonic pachymetry intra-operatively and standardizing graft preparation, most manually dissected endothelial lamellae were ultrathin. Pachy-DSEK was safe and effective for treating endothelial disfunction in eyes with ocular comorbidities. It may be a cost-effective alternative to automated dissection methods.

Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: prospective study

“…1 Two major advances in corneal surgery have played an important role in avoiding PKA: femtosecond laserassisted keratoplasty and endothelial keratoplasty. [5][6][7][8] Nevertheless, these modalities of transplantation are not indicated for every case.…”

Pediatric corneal transplantation: techniques, challenges, and outcomes

“…In DSEK, the graft is obtained using manual dissection, whereas in DSAEK, the process is automated using a microkeratome which creates a more regular interface [ Figure 1(e) ]. 92 , 93 Another surgical procedure that is very similar to DSEK and DSAEK is Pre-Descemet’s Endothelial Keratoplasty (PDEK). In this procedure, the pre-Descemet’s layer (Dua’s layer) is transplanted along with the Descemet-endothelial complex.…”

Associação de implante de segmentos de anéis corneanos intraestromais com ceratectomia fotorrefrativa para tratamento de alto astigmatismo após ceratoplastia penetrante

“…24 O transplante lamelar posterior resolveu essa complicação nos casos em que a indicação se dá por disfunção do endotélio (como na CBP ou na distrofia endotelial de Fuchs) na medida em que se preservam as camadas corneanas anteriores do receptor. 25 Entretanto, quando a indicação está relacionada à perda de transparência ou a alterações de curvatura (como nas ectasias corneanas), as camadas anteriores ainda são necessariamente substituídas. Consequentemente, o astigmatismo permanece sendo um entrave à reabilitação visual em uma porcentagem considerável de pacientes.…”

“…Habitualmente, o ARPT de baixa monta (<6,0 D) e regular é tratado com sucesso através de adaptação de óculos ou lentes de contato. [23][24][25][26][27]107,108 Contrariamente, o ARPT de alta monta (>6,0 D) ou irregular requer tratamento cirúrgico com maior frequência. Apesar de melhorar a performance visual após TCP na maioria dos casos, a adaptação de óculos nem sempre é realizada.…”