Massimo Busin1, Pia Leon2, Vincenzo Scorcia3, Diego Ponzin4. 1. Department of Ophthalmology, Ospedale Privato "Villa Igea", Forlì, Italy; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy. Electronic address: mbusin@yahoo.com. 2. Department of Ophthalmology, Ospedale Privato "Villa Igea", Forlì, Italy; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy. 3. Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy. 4. Fondazione Banca degli Occhi del Veneto (FBOV), Venezia, Italy.
Abstract
PURPOSE: To evaluate the feasibility and outcomes of contact lens-assisted bimanual pull-through delivery of Descemet membrane endothelial keratoplasty (DMEK) tissue trifolded with the endothelium inward. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Forty-two consecutive eyes of 42 patients with Fuchs endothelial dystrophy with or without cataract. INTERVENTION: Standardized DMEK was performed as a single procedure (n = 9) or in combination with phacoemulsification and implantation of a posterior chamber intraocular lens (n = 33) using prestripped donor tissue punched to a diameter of 8.25 mm and then trifolded with the endothelium in. Using a sterile soft contact lens as scaffold, the tissue was loaded in this configuration into a disposable cartridge and delivered into the anterior chamber under continuous irrigation using a bimanual pull-through technique to facilitate spontaneous proper unfolding. MAIN OUTCOME MEASURES: Surgical time, intraoperative and postoperative complications, visual acuity 3 and 6 months after surgery, and endothelial cell loss 6 months after surgery. RESULTS: Surgery was uneventful in all cases and the time required for the DMEK procedure (from Descemet scoring until final air filling) never exceeded 20 minutes (average, 17.1±1.6 minutes). The only complication observed after surgery was graft detachment (10 of 42 eyes [23.8%]), successfully managed in all cases by single rebubbling within 6 days from surgery. In all eyes with a minimum postoperative follow-up of 6 months (n = 20), best spectacle-corrected visual acuity was 20/25 or better and the average endothelial cell density (±standard deviation) was 2363.8±82.7 cells/mm(2) (range, 2258-2490 cells/mm(2)). The cell loss calculated as a percentage of the preoperative value determined at the eye bank (range, 2500-2700 cells/mm(2)) was 9.9±2.1% (range, 4.1%-11.9%). CONCLUSIONS: Delivering DMEK tissue, trifolded with the endothelium inward, reduces surgical trauma to donor cells and facilitates spontaneous unfolding, thus minimizing surgical time.
PURPOSE: To evaluate the feasibility and outcomes of contact lens-assisted bimanual pull-through delivery of Descemet membrane endothelial keratoplasty (DMEK) tissue trifolded with the endothelium inward. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Forty-two consecutive eyes of 42 patients with Fuchs endothelial dystrophy with or without cataract. INTERVENTION: Standardized DMEK was performed as a single procedure (n = 9) or in combination with phacoemulsification and implantation of a posterior chamber intraocular lens (n = 33) using prestripped donor tissue punched to a diameter of 8.25 mm and then trifolded with the endothelium in. Using a sterile soft contact lens as scaffold, the tissue was loaded in this configuration into a disposable cartridge and delivered into the anterior chamber under continuous irrigation using a bimanual pull-through technique to facilitate spontaneous proper unfolding. MAIN OUTCOME MEASURES: Surgical time, intraoperative and postoperative complications, visual acuity 3 and 6 months after surgery, and endothelial cell loss 6 months after surgery. RESULTS: Surgery was uneventful in all cases and the time required for the DMEK procedure (from Descemet scoring until final air filling) never exceeded 20 minutes (average, 17.1±1.6 minutes). The only complication observed after surgery was graft detachment (10 of 42 eyes [23.8%]), successfully managed in all cases by single rebubbling within 6 days from surgery. In all eyes with a minimum postoperative follow-up of 6 months (n = 20), best spectacle-corrected visual acuity was 20/25 or better and the average endothelial cell density (±standard deviation) was 2363.8±82.7 cells/mm(2) (range, 2258-2490 cells/mm(2)). The cell loss calculated as a percentage of the preoperative value determined at the eye bank (range, 2500-2700 cells/mm(2)) was 9.9±2.1% (range, 4.1%-11.9%). CONCLUSIONS: Delivering DMEK tissue, trifolded with the endothelium inward, reduces surgical trauma to donor cells and facilitates spontaneous unfolding, thus minimizing surgical time.
Authors: Kali Barnes; Eric Chiang; Conan Chen; John Lohmeier; Jason Christy; Akash Chaurasia; Allison Rosen; Parth Vora; Stephanie Cai; Anshul Subramanya; Nicholas Durr; Robert Allen; Allen Omid Eghrari Journal: Cornea Date: 2019-03 Impact factor: 2.651
Authors: Sezen Karakus; Mehrnaz Ighani; Puntakarn Noparat; Marjan Tofigh; Eric Chiang; Kali Barnes; Conan Y Chen; Tiffany S Liu; Allen O Eghrari Journal: Cornea Date: 2019-05 Impact factor: 2.651
Authors: Meraf A Wolle; David L DeMill; Lauren Johnson; Stephen I Lentz; Maria A Woodward; Shahzad I Mian Journal: Cornea Date: 2017-11 Impact factor: 2.651
Authors: Vito Romano; Mohit Parekh; Alessandro Ruzza; Colin E Willoughby; Stefano Ferrari; Diego Ponzin; Stephen B Kaye; Hannah J Levis Journal: Br J Ophthalmol Date: 2017-11-13 Impact factor: 4.638