1
|
Flockerzi E, Turner C, Seitz B, Collaborators GSG. Descemet's membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol 2024; 108:646-653. [PMID: 37586835 PMCID: PMC11137454 DOI: 10.1136/bjo-2022-323162] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/12/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND/AIMS This retrospective multicentric panel study provides absolute numbers, types of and indications for corneal transplantation in Germany from 2011 to 2021 and sets them into the international context. METHODS A questionnaire was sent to the 104 German ophthalmologic surgery departments and 93 (89%) provided their data. RESULTS The number of reported keratoplasties more than doubled from 2011 (n=4474) to 2021 (n=8998). Lamellar keratoplasties (49% posterior (n=2883), 4% anterior (n=231)) surpassed penetrating keratoplasty (PKP, 47%, n=2721) for the first time in 2014. Since 2016, Descemet's membrane endothelial keratoplasty (DMEK) has become the predominant keratoplasty procedure in Germany. Its number increased by 1.5-fold from 3850 (2016) to 5812 (2021). Main indications in 2021 were Fuchs' endothelial corneal dystrophy (FECD, 43%), pseudophakic corneal decompensation (12%), repeated keratoplasty (11%), infections (7%), keratoconus (6%) and corneal scarring (4%, others: 9%). The PKP percentage decreased from 70.2% in 2011 (n=3141) to 31.7% in 2021 (n=2853). Descemet's stripping (automated) endothelial keratoplasties (DSAEKs) decreased to 1% in 2021 (n=74). 98.6% of all posterior lamellar keratoplasties were DMEKs in Germany in 2021. The number of deep anterior lamellar keratoplasties (DALKs) remained comparable from 2011 (n=269) to 2021 (n=251, 2.8%). CONCLUSION Main indications for corneal transplantation in Germany (2021) were FECD and pseudophakic corneal decompensation. DMEK is by far the predominant corneal transplantation procedure since 2016 followed by PKP, whose absolute number decreased only slightly during the decade from 2011 to 2021. DALK proportions remain low, but stable, whereas DSAEK decreased annually and plays a minor role in Germany. TRIAL REGISTRATION NUMBER NCT03381794.
Collapse
Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Christina Turner
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - GeKeR Study Group Collaborators
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| |
Collapse
|
2
|
Tong CM, Ellis D, Kissick B, Kurji K, Mah DY, Climenhaga DB. Cost-effectiveness of locally prepared Descemet membrane endothelial keratoplasty grafts in Edmonton. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:413-416. [PMID: 35594911 DOI: 10.1016/j.jcjo.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to show the cost-effective benefits of creating a sustainable local program where Descemet membrane endothelial keratoplasty (DMEK) grafts were prepared locally instead of imported from American eye banks. DESIGN Retrospective observational study. METHODS In 2018, 2 local technicians were trained to prestrip DMEK grafts in Edmonton up to 2 days before surgery when local donor tissue was available. When no local tissue was available, prestripped DMEK grafts were imported from U.S. eye banks. The total cost of locally prepared and imported DMEK grafts over 27 months was compared with the cost that otherwise would have been accrued if all DMEK grafts had been imported. RESULTS Over 27 months, 82 DMEK grafts (55.3%) were prepared locally and 63 DMEK grafts (44.7%) were imported. The total cost of preparing 82 grafts locally was $9349.19. The total cost of importing 63 prestripped DMEK grafts was $282 431.52. The combined total cost of locally prepared and imported DMEK grafts was $291 780.71. The total cost that otherwise would have been incurred if every graft was imported was $632 108.64. This difference in costs was $340 327.93 over 27 months. CONCLUSIONS Establishing a sustainable program to make high-quality DMEK grafts with local donor corneas is a cost-effective alternative to importing prestripped DMEK grafts in Edmonton.
Collapse
Affiliation(s)
- C Maya Tong
- University of Alberta, Edmonton, Alta; University of Montreal, Montreal, Que.
| | | | | | | | | | | |
Collapse
|
3
|
Go J, Tran J, Khan M, Al-Mohtaseb Z. Application of data mining algorithms to study data trends for corneal transplantation. J Fr Ophtalmol 2022; 45:700-709. [DOI: 10.1016/j.jfo.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
|
4
|
Händel A, Siebelmann S, Matthaei M, Cursiefen C, Bachmann B. Mini-DMEK for the Treatment of Chronic Focal Corneal Endothelial Decompensation. Cornea 2022; 42:12-19. [DOI: 10.1097/ico.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
|
5
|
Chilibeck CM, Brookes NH, Gokul A, Kim BZ, Twohill HC, Moffatt SL, Pendergrast DG, McGhee CNJ. Changing Trends in Corneal Transplantation in Aotearoa/New Zealand, 1991 to 2020: Effects of Population Growth, Cataract Surgery, Endothelial Keratoplasty, and Corneal Cross-Linking for Keratoconus. Cornea 2022; 41:680-687. [PMID: 34267061 DOI: 10.1097/ico.0000000000002812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify trends in the primary indication for keratoplasty in New Zealand/Aotearoa (NZ) after significant population growth, increase in the number of cataract surgeries per population, widespread adoption of endothelial keratoplasty, and introduction of corneal cross-linking for keratoconus. METHODS Statistical analysis of the New Zealand National Eye Bank's prospective database of all keratoplasties was performed between January 1991 and January 2020. Indications for keratoplasty were isolated for the primary diagnosis. RESULTS In total, 6840 corneas were transplanted with mean 236 ± 57.5 transplants/year, increasing from 2.55 to 6.06 per 100,000 NZ population/year. Over the past decade, the number of transplant recipients aged 60 years or older has increased and recipients aged 20 to 39 years have plateaued. In 2019, for the first time, regraft became the most common indication (30.9%), followed by keratoconus (27.9%) and corneal dystrophy (18.8%), with a steady decline in bullous keratopathy. Proportions of the keratoplasty technique changed dramatically: penetrating keratoplasty fell from 91.4% in 2006 to 55.0% in 2019, Descemet's stripping endothelial keratoplasty increased from 0% to 29.5%, anterior lamellar keratoplasty increased from 2.5% to 5.7%, and Descemet membrane endothelial keratoplasty increased from 0% to 9.1%. CONCLUSIONS Keratoplasty trends in Aotearoa/NZ have changed considerably because of the evolution of phacoemulsification and keratoplasty techniques. Unlike proportions observed overseas, NZ still performs penetrating keratoplasties in over half of all transplants. Corneal cross-linking may be having an early effect of reducing keratoplasty rates for keratoconus.
Collapse
Affiliation(s)
- Corina M Chilibeck
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
| | - Nigel H Brookes
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
| | - Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
| | - Helen C Twohill
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Louise Moffatt
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David G Pendergrast
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Sabater-Cruz N, Figueras-Roca M, Padró-Pitarch L, Tort J, Casaroli-Marano RP. Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques. PLoS One 2021; 16:e0249946. [PMID: 33831081 PMCID: PMC8031423 DOI: 10.1371/journal.pone.0249946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period. Methods Annual reports from the Catalan Transplant Organization, Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed. Results A total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067). Conclusion Endothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent with the main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach.
Collapse
Affiliation(s)
- Noelia Sabater-Cruz
- Institut Clinic d’Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
- * E-mail:
| | - Marc Figueras-Roca
- Institut Clinic d’Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lydia Padró-Pitarch
- Catalan Transplant Organization (Organització Catalana de Trasplantaments—OCATT), Barcelona, Spain
| | - Jaume Tort
- Catalan Transplant Organization (Organització Catalana de Trasplantaments—OCATT), Barcelona, Spain
| | - Ricardo P. Casaroli-Marano
- Institut Clinic d’Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Department of Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Non stripping descemet membrane endothelial keratoplasty in difficult cases: A case series. J Fr Ophtalmol 2021; 44:687-692. [PMID: 33752900 DOI: 10.1016/j.jfo.2020.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
Abstract
Endothelial keratoplasty (EK) has been increasingly used instead of penetrating keratoplasty (PK) in the management of post PK graft rejection. Both DSAEK and DMEK involve the surgical removal of the diseased host endothelial cell layer and Descemet's membrane (DM) (descemetorhexis) before transplantation, a technically challenging step, especially in post-PK eyes. Understandably, interest arose when non-stripping DMEK (nDMEK) was described in 2013, and recent studies suggested encouraging results without increased early postoperative failures or complications requiring rebubbling. The purpose of our series was to further study the feasibility and safety of nDMEK and to compare the results with traditional DMEK. This is a single center case series of 3 eyes which underwent nDMEK performed by experienced surgeons (C.P, A.M). Two eyes had nDMEK as a secondary procedure following a failed/rejected PK, while the third case underwent nDMEK on a virgin eye. Undiseased donor DM and a regular host endothelium were required to be eligible for nDMEK. The average change in CCT at last follow-up was -21.2% (±13.3). All required intracameral air injection (rebubbling) within the first few days, with a mean of 2.33 rebubblings per eye, the first one occurring at 6.33±2.52 days after surgery. Non-stripping DMEK surgery appears to be a feasible option, and results are satisfactory at mid to long term. However, in our series, the immediate postoperative period was marked by an increased rebubbling rate. While foreseeable particularly in high-risk cases, surgeons considering this technique should expect a higher risk of early rejection.
Collapse
|
8
|
Sabater-Cruz N, Otero N, Dotti-Boada M, Ríos J, Gris O, Güell JL, Vilarrodona A, Casaroli-Marano RP. Eye bank and theatre factors for positive microbiological culture of corneoscleral rim and cornea storage medium in the real-world. Eye (Lond) 2021; 35:3087-3093. [PMID: 33469128 DOI: 10.1038/s41433-020-01342-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate microbiological culture rate and positivity of corneoscleral rim and cornea storage media as well as possible risk factors for contamination with real-world data. METHODS Data of consecutive cornea donors implanted in the reference centre from January 2013 to January 2018 were reviewed. Information about cornea characteristics (donor demographic data, endothelial cell density, type of cornea conservation, days of storage, and precut vs full-thickness tissue), and microbiological culture information (corneoscleral rim vs storage sample, positive result) were statistically analysed. RESULTS During the study period, 1369 corneas (737 donors) were implanted. Cultures were performed in 76.8% (n = 1052) of them and were positive in 3.2% of cases, mainly bacteria (84.4%). Corneas preserved in hypothermia represented 61.8% of all positive microbiology results (p < 0.001). Other analysed risk factors did not reach statistically significant association with microbiological positivity. None of the 34 cases with positive microbiological cultures reported ocular infection for the recipients in at least 6 months' follow-up. CONCLUSIONS Microbiological tests rate in real-world practice are high despite not being compulsory. Organotypic cultured corneas showed a statistically less positivity in corneoscleral and storage medium than hypothermic ones, resulting in another advantage of this kind of cornea storage. Although precut corneas are thought to present less microbiological positivity, a statistically significant association was not found in the present study.
Collapse
Affiliation(s)
- Noelia Sabater-Cruz
- Hospital Clinic de Barcelona, Barcelona, Spain. .,Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain.
| | | | | | - José Ríos
- Hospital Clinic de Barcelona, Barcelona, Spain.,Medical Statistics Core Facility (IDIBAPS) and Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gris
- Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
| | - José L Güell
- Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
| | | | - Ricardo P Casaroli-Marano
- Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain.,Barcelona Tissue Bank (BST-BTB), Barcelona, Spain
| |
Collapse
|
9
|
Shahnazaryan D, Hajjar Sese A, Hollick EJ. Endothelial Cell Loss After Descemet's Membrane Endothelial Keratoplasty for Fuchs' Endothelial Dystrophy: DMEK Compared to Triple DMEK. Am J Ophthalmol 2020; 218:1-6. [PMID: 32437670 DOI: 10.1016/j.ajo.2020.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study compared the outcomes after Descemet's membrane endothelial keratoplasty (DMEK) in pseudophakic patients with the outcomes after DMEK combined with cataract surgery (triple-DMEK) in patients with Fuchs' endothelial dystrophy (FED). DESIGN Retrospective, single-institution, interventional, consecutive case series. METHODS Outcomes of 114 DMEKs in patients with FED at a minimum of 1-year follow-up were reviewed. A total of 34 eyes (29 patients) were pseudophakic and underwent only DMEK (DMEK-only), and 80 eyes (56 patients) underwent triple-DMEK. Main outcome measurements included endothelial cell loss (ECL), best-corrected visual acuity (BCVA), central corneal thickness (CCT), and complications. RESULTS At 1 month, ECL was 25% (±16%) and 35% (±15%) in DMEK-only and triple-DMEK groups, respectively. At 1 year, ECL was 33% (±13%) and 41% (±16%) in DMEK-only and triple-DMEK groups, respectively. There was statistically significantly less ECL after DMEK-only than after triple-DMEK at both 1 month (95% confidence interval [CI]: 1.67-15.02; P = .016) and 1 year (95% CI: 1.06-14.07; P = .034). CCT was significantly lower after DMEK-only than after triple-DMEK at 1 month but not at 1 year. BCVA was excellent and similar in the 2 groups. There were no cases of graft failure. Graft rejection and rebubbling rates were similar in DMEK-only and triple-DMEK groups: rejection occured in 8.8% and 8.75% of cases respectively (P = .50), and rebubbling in 2.9% and 2.5% respectively (P = .44). CONCLUSIONS Both the DMEK-only and the triple-DMEK groups had low rebubbling rates and good visual outcomes, but the combined triple-DMEK procedure resulted in significantly greater loss of endothelial cells than DMEK-only surgery at both 1 month and 1 year.
Collapse
|