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Hybrid Descemet Membrane Endothelial Keratoplasty (H-DMEK): results of a donor insertion pull-through technique using donor stroma as carrier.
- Source :
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The British journal of ophthalmology [Br J Ophthalmol] 2020 Oct; Vol. 104 (10), pp. 1358-1362. Date of Electronic Publication: 2020 Jan 16. - Publication Year :
- 2020
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Abstract
- Aim: To evaluate the outcomes and complications of hybrid Descemet membrane endothelial keratoplasty (H-DMEK) using a Descemet stripping automated endothelial keratoplasty (DSAEK) pull-through donor inserter and donor stroma as carrier.<br />Methods: This was a retrospective interventional case series of eyes with bullous keratopathy (BK) and Fuchs endothelial corneal dystrophy (FECD), which underwent H-DMEK, performed using a bimanual pull-through technique using DSAEK-prepared donor stroma as carrier and the EndoGlide Ultrathin DSAEK donor insertion device. Complex cases with tube shunts, trabeculectomy, aphakia, aniridia, previous vitrectomy, keratoplasty or combined with intraocular lens exchange, were also included. The outcome measures were intraoperative and postoperative complications, best corrected visual acuity (BCVA) and endothelial cell loss after surgery.<br />Results: Of the 85 eyes from 79 patients, 43.5% (n=37) had BK, 28.2% (n=24) had FECD while 24.7% (n=21) had failed grafts. DMEK was performed in 37 complex eyes (43.5%). Four eyes (4.7%) required rebubbling for graft detachment and two cases of graft failure were observed. A BCVA of 20/25 or better was attained in 44.7% and 57.1% of eyes without pre-existing ocular pathology at 6 and 12 months, respectively. The overall endothelial cell loss was 32.2%±20.5% at 6 months, which improved from 37.2%±20.9% to 24.2%±17.5%, comparing the first 40 and last 45 cases (p=0.012).<br />Conclusion: Hybrid DMEK offers a controlled 'pull-through' technique of donor insertion in the 'endothelium-in' configuration, which may be useful especially in complicated eyes. More studies are needed to confirm the long-term endothelial cell loss and graft survival associated with this technique.<br />Competing Interests: Competing interests: DT: Patent of EndoGlide (royalties to Network Medical)<br /> (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Aged
Corneal Diseases physiopathology
Corneal Diseases surgery
Corneal Endothelial Cell Loss
Descemet Stripping Endothelial Keratoplasty instrumentation
Female
Fuchs' Endothelial Dystrophy physiopathology
Graft Survival
Humans
Intraoperative Complications
Male
Middle Aged
Postoperative Complications
Reoperation
Retrospective Studies
Tissue Donors
Treatment Outcome
Visual Acuity physiology
Corneal Stroma surgery
Descemet Membrane surgery
Descemet Stripping Endothelial Keratoplasty methods
Fuchs' Endothelial Dystrophy surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1468-2079
- Volume :
- 104
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- The British journal of ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 31949091
- Full Text :
- https://doi.org/10.1136/bjophthalmol-2019-314932