scholarly journals Non-Descemet Stripping Automated Endothelial Keratoplasty for Bullous Keratopathy in Buphthalmic Eye

2016 ◽  
Vol 7 (2) ◽  
pp. 279-284 ◽  
Author(s):  
Koji Hirano ◽  
Shu Kachi ◽  
Masako Matsuura ◽  
Kazuhide Kawase ◽  
Won Sun Park
Keyword(s):  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Crystalline Lens ◽  
Bullous Keratopathy ◽  
Topical Steroids ◽  
Endothelial Keratoplasty ◽  
Corrected Visual Acuity ◽  
The Right ◽  
Phakic Eyes

Purpose: To report the 2-year follow-up findings in a patient with buphthalmic bullous keratopathy (BK) who was successfully treated with non-Descemet stripping automated endothelial keratoplasty (nDSAEK). Methods: A 39-year-old man had an endothelial graft of 8.0 mm diameter placed uneventfully using the nDSAEK method for phakic BK with buphthalmos of the left eye. He had had a penetrating keratoplasty in the right eye due to aphakic BK 5 years earlier, which, however, resulted in the invasion of blood vessels and graft failure. Since the left eye was phakic, Descemetorhexis was not performed because the instruments might touch the crystalline lens. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at 2 weeks, and at 1, 3, 6, 12, 18 and 24 months after nDSAEK. Results: Twenty-four months after nDSAEK, his left cornea and lens remained clear, and the decimal BCVA was 0.8. However, the ECD of the graft had decreased from 2,274 cells/mm2 before nDSAEK to 539 cells/mm2 24 months after the surgery, and the rate of decrease appeared to be slightly faster than that of former reports. An IOP of >30 mm Hg was recorded at around 2 months after the surgery, but was well controlled by tapering the topical steroids and the addition of topical brinzolamide and latanoprost. Conclusion: Our findings show that nDSAEK can be successfully used to treat buphthalmic BK. We recommend that nDSAEK be considered especially in phakic eyes with a smooth posterior surface around the pupillary area.

scholarly journals Outcomes of Resident-Performed Descemet's Stripping Automated Endothelial Keratoplasty

2017 ◽  
Vol 09 (01) ◽  
pp. e26-e31
Author(s):  
Tatyana Beketova ◽  
Margaret Pfeiffer ◽  
Alice Chuang ◽  
Gene Kim
Keyword(s):  
Graft Failure ◽  
Glaucoma Patient ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Ocular Surgery ◽  
Pseudophakic Bullous Keratopathy ◽  
Primary Graft Failure

Purpose This article aimed to evaluate outcomes of resident-performed Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods This is a case series of patients who underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery. Results Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline. Conclusion With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes.

Ten-Year Survival of Optical Penetrating Keratoplasty and Risk Factors for Graft Failure in Thai Patients

2020 ◽  
Vol 103 (9) ◽  
pp. 883-890
Keyword(s):  
Risk Factors ◽  
Graft Survival ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Significant Risk ◽  
Visual Outcome ◽  
Successful Outcome ◽  
Bullous Keratopathy ◽  
One Year

Objective: To determine long-term graft survival and identify risk factors for secondary graft failure of optical penetrating keratoplasty (PK) in Thai patients. Materials and Methods: A Retrospective study of patients that underwent optical PK at Siriraj Hospital between January 2002 and December 2005 was done. Results: Of 131 eyes, primary graft failure was found in two eyes (1.5%) thus, 129 eyes were recruited. The three most common surgical indications were pseudophakic or aphakic bullous keratopathy (33.3%), corneal scars (post-trauma, post-infection) (20.9%), and regrafts (16.3%). Mean follow-up period was 93.2 months (1 to 183 months). One-year, 2-year, 5-year, and 10-year graft survival rates were 84.5%, 73.2%, 50.2%, and 24.7%, respectively. The leading cause of graft failure was irreversible allograft rejection (62.5%). Most (56.0%) of the first graft rejection happened within one year post-operatively. Graft survival was lower in eyes with regrafts, history of glaucoma, deep corneal vascularization, peripheral anterior synechiae, and occurrence of one or more rejection episodes. Multivariate regression analysis demonstrated that peripheral anterior synechiae and occurrence of one or more rejection episodes were the significant independent risk factors for graft failure. Considering patients with the clear grafts at the last follow-up, the final best-corrected visual acuity was 6/36 or better in 66.7% eyes and 6/18 or better in 31.6% eyes. Comparing to pre-operative vision, patients with the clear grafts at the last follow-up had improved visual outcome in most eyes (82.5%). Conclusion: Ten-year survival and visual outcome of optical PK showed successful outcome, however, the survival rate decreased over time. The significant risk factors for graft failure should be cautiously evaluated before surgery. Keywords: Corneal graft survival, Keratoplasty outcome, Optical penetrating keratoplasty

scholarly journals Spontaneous Corneal Clearance in the Presence of a Partially Detached Graft after Non-Descemet Stripping Automated Endothelial Keratoplasty

2016 ◽  
Vol 7 (2) ◽  
pp. 320-326 ◽  
Author(s):  
Konstantinos Droutsas ◽  
Apostolos Lazaridis ◽  
Chrysanthi Koutsandrea ◽  
Klio I. Chatzistefanou ◽  
Marilita M. Moschos ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Visual Acuity ◽  
Bullous Keratopathy ◽  
Spontaneous Clearance ◽  
Endothelial Keratoplasty ◽  
Invasive Treatment ◽  
Corrected Visual Acuity ◽  
Simplex Virus ◽  
The Right

Purpose: To report the explantation of a detached and opaque donor disc as an alternative to secondary keratoplasty in a case of persistent graft detachment followed by spontaneous clearance of the recipient cornea after non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). Methods: A 57-year-old man with cataract and bullous keratopathy after herpes simplex virus endotheliitis of the right eye and best spectacle-corrected visual acuity (BSCVA) of 0.1 underwent simultaneous phacoemulsification and non-DSAEK. Due to early detachment of the donor disc, two additional intracameral air injections were necessary in order to achieve graft attachment. However, the donor disc gradually detached and became fibrotic while the recipient cornea anterior to the detached graft became transparent and without any edema. Therefore, a mere explantation of the DSAEK graft was performed. Results: Four months after graft explantation, BSCVA was 0.5 and endothelial cell density (ECD) was 1,221 cells/mm2. After 13 months, BSCVA was still 0.6 while ECD had fell to 800, and 2 years later, the endothelium decompensated. BSCVA was 0.3 and ECD was not measurable. Conclusions: To our knowledge this is the first report of explantation of an endothelial graft as an alternative to re-keratoplasty in a case of spontaneous corneal clearance. This minimally invasive treatment may be considered in similar cases. However, due to the ongoing loss of endothelial cells after endothelial keratoplasty, a re-keratoplasty may still be needed in the long term.

scholarly journals Preoperative Evaluation in Descemet Membrane Endothelial Keratoplasty for Secondary Penetrating Keratoplasty Graft Failure

2020 ◽  
Author(s):  
Khaled Safadi ◽  
Ron Kaufman ◽  
Eleanor Nche ◽  
Denise Wajnsztajn ◽  
Itay Lavy
Keyword(s):  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Medical Center ◽  
Preoperative Evaluation ◽  
Anterior Segment ◽  
P Value ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Abstract Background: Over the past decade, Penetrating Keratoplasty (PKP) graft failure has been increasingly managed by Descemet Membrane Endothelial Keratoplasty (DMEK). Our aim is to emphasis the importance of preoperative evaluation by Anterior-Segment Optical Coherence Tomography (AS-OCT) and present the clinical outcomes and surgical modifications of DMEK performed for Secondary PKP graft failure.Methods: A retrospective medical records review of patients that underwent DMEK for failed PKP at Hadassah Medical Center in 2018-2019. Collected data included demographic characteristics, PKP graft size measured by AS-OCT, corneal donor endothelial cell density (ECD), intra-operative surgical method adjustments, post-operative complications, visual acuity in Snellen (VA), central pachymetry and post-operative ECD.Results: Included were 16 patients (9 males) and 16 eyes. The study period was 18 months. Mean age at performing DMEK was 63 years. Before DMEK, mean VA and central pachymetry were 0.04 and 685µm, respectively. At last follow up, they significantly improved to 0.3 (p-value=0.001) and 542µm (p-value=0.008) respectively. Mean ECD for donor grafts was 2662 cells per mm2. Post-operative ECD was available only for 7 cases with a mean of 1391 cells per mm2 (p-value=0.0002). At last follow up, 93.75% of the grafts were attached. Graft failure rate was 6.25% due to late decompensation, graft detachment rate and rebubbling rate were 18.75% respectively. Conclusion: A suitable case-based pre-operative evaluation by AS-OCT may play a vital role in DMEK for failed PKP. No less important is to take into consideration multiple surgical adjustments. Both may further decrease complications rates along with accelerating visual recovery.

scholarly journals Evaluation of Donor and Recipient Characteristics Involved in Descemet Stripping Automated Endothelial Keratoplasty Outcomes

2021 ◽  
Vol 8 ◽  
Author(s):  
Michele Lanza ◽  
Rosa Boccia ◽  
Adriano Ruggiero ◽  
Paolo Melillo ◽  
Mario Bifani Sconocchia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Eye Bank ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Aims: To evaluate both donor and recipient features involved in visual acuity restoring and complication insurgence in eyes that have undergone Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: In this retrospective study, charts of 111 eyes of 96 patients (mean age 70.25 ± 8.58 years) that underwent DSAEK were evaluated. Only Fuch's Distrophy (FD) or Bullous Keratopathy (BK) due to cataract surgery eyes were included. A complete ophthalmic check with endothelial cell density (ECD) and central corneal thickness (CCT) measurement was performed before surgery and at 1, 3, 6, and 12 months follow-up. Each DSAEK was performed by the same well-trained surgeon; only pre-cut lenticules, provided by same Eye Bank, were implanted.Results: A total of 48 (43%) complications have been observed (most of them were 22 partial graft detachments and 17 IOP spikes). At the last follow-up (mean: 8.58 ± 4.09 months), a significant increase (p < 0.05) of best corrected visual acuity (BCVA) was detected. Overall mean BCVA of the eyes evaluated was 0.40 ± 0.43 LogMAR with BK eyes showing a significantly higher improvement (p < 0.05) compared to FD eyes. The only factor showing a significant correlation (p < 0.05) with visual acuity enhancement was the implant of a lenticule thinner than 100 μm. Recipient features significantly (p < 0.05) associated with complications observed after surgery were glaucoma and diabetes mellitus.Conclusion: The use of a graft thinner than 100 μm can provide better visual acuity recovery while recipients affected by glaucoma or diabetes mellitus are more prone to develop complications after surgery.

scholarly journals A Case of Descemet’s Membrane Endothelial Keratoplasty in a failed Penetrating Keratoplasty

2018 ◽  
Vol 10 (2) ◽  
pp. 188-192
Author(s):  
Sanjay Kumar Singh ◽  
Reena Yadav ◽  
Ashmita Sharma
Keyword(s):  
Penetrating Keratoplasty ◽  
Invasive Procedure ◽  
Endothelial Keratoplasty ◽  
Visual Rehabilitation ◽  
Descemet’S Membrane Endothelial Keratoplasty ◽  
Descemet's Membrane ◽  
Stromal Edema ◽  
Descemet’S Membrane ◽  
The Right

Background: Descemet’s membrane endothelial keratoplasty (DMEK) is an evolving option for failed penetrating keratoplasty (PK) as it has shown promising results compared to repeat PK. Case description: A 22 years young gentleman presented with gradual diminution of vision in the left eye (LE) for six months following therapeutic PK for a perforated fungal corneal ulcer. His best spectacle corrected visual acuity (BSCVA) was 6/60 in LE. Slit-lamp examination of LE revealed circumcorneal congestion with full thickness corneal graft with micro and macrobullae, diffuse stromal edema, DM folds and seven well-buried sutures. Intraocular pressure was 20 mmHg in the right eye whereas it could not be assessed in the left eye. The diagnosis of LE failed PK was made and the patient underwent DMEK. At four months postoperative follow up visit, BSCVA improved to 6/9. This is the first reported case of DMEK after a failed PK in a  young patient from Nepal which was successfully treated without any complications. Conclusion: DMEK has a higher potential for better visual rehabilitation compared to DSEK and PK. It has also proved its efficacy in the treatment of endothelial graft failure following PK as it is a less invasive procedure.

scholarly journals Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Zahra Ashena ◽  
Thomas Hickman-Casey ◽  
Mayank A. Nanavaty
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

2021 ◽  
Author(s):  
Sonja Heinzelmann ◽  
Daniel Böhringer ◽  
Philip Christian Maier ◽  
Berthold Seitz ◽  
Claus Cursiefen ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Cost Benefit ◽  
Topical Steroids ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Open Questions ◽  
The Face

Abstract Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

scholarly journals Descemet stripping endothelial keratoplasty: One-year follow-up

2010 ◽  
Vol 138 (11-12) ◽  
pp. 690-693
Author(s):  
Ljubisa Nikolic ◽  
Vesna Jovanovic
Keyword(s):  
Corneal Thickness ◽  
Long Term Results ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Air Bubble ◽  
Primary Graft Failure ◽  
Internal Side ◽  
One Year

Introduction. Sutureless transplantation of endothelium on a thin stromal carrier was introduced under the name of Descemet stripping endothelial keratoplasty (DSEK) in 2004. It has become the treatment of choice of corneal oedema due to endothelial dysfunction. Objective. To investigate posterior lamellar graft attachment, central corneal thickness (CCT), astigmatism, and best corrected visual acuity (BCVA) during one-year follow-up. Methods. Surgery was performed on one eye of 11 patients with pseudophakic bullous keratopathy and Fuchs? dystrophy. The graft thick 150-200 ?m and 8.0 mm in diameter was detached manually. The carrier of the recipient cornea was created by DSEK. The graft was folded in half, introduced into the anterior orbital chamber through a 5.0 mm cut on the limbus and attached by air bubble along the internal side of the recipient cornea. CCT and astigmatism were evaluated by corneal topography, and graft attachment by biomicroscopy. Results. One year after surgery, all grafts remained attached. Primary graft failure occurred in three eyes, probably due to the crushing effect of the forceps. BCVA was 20/30 (2 eyes), and 20/40 (6 eyes), CCT 643-728 ?m, and astigmatism 1.1 D to 2.9 D. The peak values were reached three months after surgery, and did not change much afterwards. Conclusion. This is the first report on the long-term results of DSEK in our literature. The results are similar to those obtained by more experienced DSEK surgeons, and suggest that this procedure is safe and successful.

Systematic review and meta-analysis of femtosecond laser–enabled keratoplasty versus conventional penetrating keratoplasty

2020 ◽  
pp. 112067212091448
Author(s):  
Yang Liu ◽  
Xiaojun Li ◽  
Wenjie Li ◽  
Xudong Jiu ◽  
Mannan Tian
Keyword(s):  
Femtosecond Laser ◽  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Mean Difference ◽  
Spherical Equivalent ◽  
Corrected Visual Acuity ◽  
Standard Mean Difference ◽  
Topographic Astigmatism ◽  
Best Corrected Visual Acuity

Purpose: The aim of this meta-analysis is to compare femtosecond laser–enabled keratoplasty with conventional penetrating keratoplasty regarding postoperative astigmatism, visual functions, graft rejection, graft failure, and complications. Methods: Eligible studies were retrieved from five mainstream electronic databases, including PubMed, Embase, Ovid MEDLINE, Cochrane Library, and ClinicalTrial.gov. Postoperative topographic astigmatism was set as the primary outcome, and best-corrected visual acuity, spherical equivalent, endothelial cell density, graft rejection, graft failure, and complications were chosen as the secondary outcomes. Standard mean difference and risk ratio were the size effects for continuous data and binomial data, respectively. The data were pooled through either the random-effects model or the fixed-effects model based on data heterogeneity. Moreover, subgroup analyses were conducted when the heterogeneity occurred distinctly (I2 > 50%). Results: A total of seven comparative studies were included. The pooled standard mean difference (−0.32, 95% confidence interval: −0.74 to 0.10) showed that femtosecond laser–enabled keratoplasty was not superior over conventional penetrating keratoplasty to decrease postoperative topographic astigmatism (p = 0.14). However, best-corrected visual acuity after femtosecond laser–enabled keratoplasty was significantly better than that after conventional penetrating keratoplasty (p = 0.00, standard mean difference: −0.23, 95% confidence interval: −0.37 to −0.10). Furthermore, endothelial cell density after femtosecond laser–enabled keratoplasty was preserved significantly better (p = 0.03, standard mean difference: 0.63, 95% confidence interval: 0.07–1.20). Moreover, spherical equivalent, graft rejection, graft failure, and complications represented no distinct differences between femtosecond laser–enabled keratoplasty and conventional penetrating keratoplasty (p > 0.05). Conclusion: Femtosecond laser–enabled keratoplasty may not be superior over conventional penetrating keratoplasty in decreasing postoperative topographic astigmatism, but might have advantages to achieve best-corrected visual acuity and endothelial cell density preservation. In addition, the two techniques seem to be comparable regarding spherical equivalent, graft rejection/failure, and complications.

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