Marcus Ang1, Jodhbir S Mehta1, Stephen D Newman2, Sang Beom Han3, Jean Chai4, Donald Tan5. 1. Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Department of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore. 2. Menicon Co Ltd, Singapore, Singapore. 3. Singapore Eye Research Institute, Singapore, Singapore; Department of Ophthalmology, Sungkyunkwan University School of Medicine, Seoul, South Korea. 4. Singapore National Eye Centre, Singapore, Singapore. 5. Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Department of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore. Electronic address: donald.tan.t.h@singhealth.com.sg.
Abstract
PURPOSE: To evaluate a novel technique of Descemet membrane endothelial keratoplasty (DMEK) donor insertion using the EndoGlide pull-through device. DESIGN: Prospective, interventional cases series. METHODS: We performed DMEK using the EndoGlide technique with a protoype donor carrier device (Descemet Mat, or D-Mat) in 30 patients by a single surgeon (including learning curve). Clinical data and donor and recipient characteristics were tracked from our prospective Singapore Corneal Transplant Registry. Main outcome measures were intraoperative complications and the incidence of postoperative graft detachment and primary graft failures within 3 months from surgery. RESULTS: In our preliminary study of 30 eyes in 30 patients (73% female, mean age 64.5 ± 8.3 years), we observed 3 cases (10%) of partial donor detachment requiring rebubbling and 1 (3%) primary donor failure. Twenty of 30 eyes (66.7%) achieved ≥20/25 3-month best spectacle-corrected visual acuity. Six-month endothelial cell loss reduced from 65% ± 13% to 48% ± 11% (P = .02) comparing the first and last 15 cases. With the exception of 1 case with excessive fibrin formation, we did not experience any further intraoperative complications related to donor tissue insertion, incomplete tissue unfolding, donor tissue malposition, or incorrect orientation. CONCLUSION: Our study suggests that the described technique allows for donor control and insertion in the correct orientation with the endothelium facing down. Further studies are required to confirm if this DMEK donor insertion technique can lead to reduced endothelial cell loss and better graft survival.
PURPOSE: To evaluate a novel technique of Descemet membrane endothelial keratoplasty (DMEK) donor insertion using the EndoGlide pull-through device. DESIGN: Prospective, interventional cases series. METHODS: We performed DMEK using the EndoGlide technique with a protoype donor carrier device (Descemet Mat, or D-Mat) in 30 patients by a single surgeon (including learning curve). Clinical data and donor and recipient characteristics were tracked from our prospective Singapore Corneal Transplant Registry. Main outcome measures were intraoperative complications and the incidence of postoperative graft detachment and primary graft failures within 3 months from surgery. RESULTS: In our preliminary study of 30 eyes in 30 patients (73% female, mean age 64.5 ± 8.3 years), we observed 3 cases (10%) of partial donordetachment requiring rebubbling and 1 (3%) primary donor failure. Twenty of 30 eyes (66.7%) achieved ≥20/25 3-month best spectacle-corrected visual acuity. Six-month endothelial cell loss reduced from 65% ± 13% to 48% ± 11% (P = .02) comparing the first and last 15 cases. With the exception of 1 case with excessive fibrin formation, we did not experience any further intraoperative complications related to donor tissue insertion, incomplete tissue unfolding, donor tissue malposition, or incorrect orientation. CONCLUSION: Our study suggests that the described technique allows for donor control and insertion in the correct orientation with the endothelium facing down. Further studies are required to confirm if this DMEK donor insertion technique can lead to reduced endothelial cell loss and better graft survival.