Transplantation of Descemet's Membrane Carrying Viable Endothelium Through a Small Scleral Incision

Melles, Gerrit R.J.; Lander, Frank; Rietveld, F.J.R.

doi:10.1097/00003226-200205000-00016

Cited by 258 publications

(161 citation statements)

References 18 publications

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“…14,15 Twenty-three patients were men and 27 women, ranging from 41 to 88 years of age (Table 1). All patients signed an IRB-approved informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…[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). [15][16][17][18] As PK has been the gold standard for keratoplasty for almost a century, 19 an alternative technique should bring major advantages in clinical outcome, reducing complications as well as technical feasibility, to get accepted and to change a longstanding consensus in ophthalmology.…”

Section: Introductionmentioning

confidence: 99%

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

Ham

Dapena

Luijk

et al. 2009

Eye

214

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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“…14,15 Twenty-three patients were men and 27 women, ranging from 41 to 88 years of age (Table 1). All patients signed an IRB-approved informed consent.…”

Section: Methodsmentioning

confidence: 99%

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

214

142

View full text Add to dashboard Cite

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“…4 This has not, as yet, become a popular technique, perhaps owing to difficulties in harvesting the donor endothelial layer and its application to the host inner corneal surface without viable endothelial cell loss.…”

Section: Introductionmentioning

confidence: 99%

A method for true endothelial cell (Tencell) transplantation using a custom-made cannula for the treatment of endothelial cell failure

Tappin

2006

Eye

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Aim To describe a novel technique, true endothelial cell (Tencell) transplant, for the transfer of donor endothelial cells with only a Descemet's carrier in patients with endothelial cell failure. Method Three patients treated for endothelial cell failure underwent Tencell transplantation. Two were performed to alleviate pain from bullous keratopathy, and one was performed to improve vision. Preoperative pain, vision, and corneal thickness were recorded and compared to the same parameters postoperatively. Results At 3 months postoperatively, all patients were pain free. The visual acuity had improved in all cases, and all three cases demonstrated a reduction of central corneal thickness. In two cases it was possible to perform an endothelial cell count. Conclusion This is the first description of Tencell transplantation in living subjects.

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“…He has also published laboratory cadaver eye studies demonstrating the feasibility of pure Descemet's membrane transplantation with endothelial survival, but no patient to date has been treated with this radical technique. 43 The key to consistent visual results remains in the improvement of the DLEK stromal interface. The use of a microkeratome for the donor side of the interface is likely, and work continues on automation of the creation of the recipient pocket side of the interface.…”

Section: The Future Of Dlek Surgerymentioning

confidence: 94%

“…27,28 Terry's first clinical series of DLEK patients was published in 2003. 30 Continued laboratory and clinical work in PLK/DLEK continues separately by Melles 42,43 and by Terry [44][45][46] with the evolution of this procedure still in progress.…”

Section: Lamellar Surgery For Endothelial Replacementmentioning

confidence: 99%

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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Transplantation of Descemet's Membrane Carrying Viable Endothelium Through a Small Scleral Incision

Abstract: DM can be transplanted in vitro with acceptable damage to the donor endothelium and with little induced astigmatism.

Cited by 258 publications

References 18 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

A method for true endothelial cell (Tencell) transplantation using a custom-made cannula for the treatment of endothelial cell failure

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

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