Technique for Preparing Ultrathin and Nanothin Descemet Stripping Automated Endothelial Keratoplasty Tissue

Abstract

We propose the term "NT-DSAEK" for grafts ≤50 μm. The described nomogram allows for standardized creation of NT grafts with a low tissue loss rate. This technique is safe and does not result in significant ECC loss compared with UT-DSAEK and DMEK grafts. Further studies are necessary to corroborate the postsurgical results of NT grafts.

Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

“…These outcomes were further supported by a large interventional case series [14] and by a recent randomized controlled clinical trial [4]. Thus, due to the higher demand and thanks to the refinement and standardization of graft cutting techniques [3,14,15], eye banks nowadays are providing surgeons with thinner grafts, often thinner than 100 μm (ultrathin) or 50 μm (nanothin) [3,16]. The increasing availability of ultrathin grafts has led to a randomized controlled clinical study [17] which found a higher visual outcome after DMEK compared to UT-DSAEK.…”

“…Due to its quicker postoperative recovery and similar or better visual outcome and lower rejection rates, DMEK has rapidly gained popularity even though its widespread adoption is still limited by the difficult and less predictable surgical technique that prevents its use in complicated cases, and by its higher rates of postoperative rebubbling [3][4][5].…”

‘Acute-angled bevel’ sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty

“…The use of modified techniques with both automated and manual microkeratomes has enabled surgeons to perform ultra-thin DSAEK with faster visual recovery and superior visual outcomes 2–4. Moreover, DSAEK has the advantage of an easier learning curve and less tissue loss during donor preparation than DMEK 5.…”

Postoperative Thinning of Lamellar Donor Graft after Conventional Descemet’s Stripping Automated Endothelial Keratoplasty

“…Futher development in DSAEK graft preparation is pushing towards more delicate and thinner lamellae, so we can describe nanothin (NT, ≤50 µm), ultrathin (UT, ≤100 µm) and conventional (≥100 µm) grafts ( 14 ).…”

“…During development of the DSAEK method, there was a change in the definition of the method subtypes depending on the thickness of the lamella. Previously defined as ultrathin DSAEK were lamellae thinner than 130 µm, although today it is considered as being thinner than 100 µm ( 6 , 8 , 14 ). These definitions are accepted by agreement of the surgeons and are not strictly defined, as confirmed by the study conducted by Chamberlain et al ., where 56% of experienced surgeons took lamellar thickness <100 µm as ultrathin and >100 µm as conventional DSAEK method ( 15 ).…”