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Zhao Z, Lin L, Zhou W, Chen J, Xiao Y, Jhanji V, Liu Y, Zheng Q, Chen W. Modified Method for Nanothin Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2024:00003226-990000000-00489. [PMID: 38381043 DOI: 10.1097/ico.0000000000003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/13/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE The purpose of this study was to describe a method to achieve a high success rate for nanothin (NT, ≤50 μm) Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation using anterior chamber pressurizer (ACP) with a modified setting and evaluate its postoperative efficacy. METHODS A prospective cohort (study group) of 24 patients with corneal endothelial dysfunction was consecutively enrolled and received DSAEK grafts using the modified ACP method from December 2021 to May 2022. The control group included 24 historical patients who received DSAEK grafts using conventional ACP procedure. Central graft thickness (CGT), graft regularity (3-mm and 5-mm diameter zones), best spectacle-corrected visual acuity, and endothelial cell density (ECD) were compared between 2 groups. RESULTS A 100% ultrathin (UT, ≤100 μm) DSAEK rate and 62.5% NT-DSAEK rate was achieved at 3 months postsurgery in the study group, with a 51.3 ± 14.8 μm CGT, while a 70.8% UT-DSAEK rate and 4.2% NT-DSAEK rate was achieved in the control group, with an 89.0 ± 15.4 μm CGT (P <0.001). At 3-month postoperative follow-up, the regularity of graft thickness was significantly better in the study group (central-to-peripheral thickness difference: P = 0.044 and 0.014 for 3-mm and 5-mm diameter zones, respectively, graft thickness uniformity: P <0.001 and 0.012, respectively). There was no statistical difference in the best spectacle-corrected visual acuity (P = 0.170) or ECD (P = 0.833) between 2 groups at 3-month postoperative follow-up. CONCLUSIONS DSAEK grafts harvested using modified ACP method were thinner and more regular compared with the conventional ACP method.
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Affiliation(s)
- Zelin Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weihe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jiaqi Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yinling Xiao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Yang Liu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qinxiang Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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The predictability of graft thickness for Descemet's stripping automated endothelial keratoplasty using a mechanical microkeratome system. Sci Rep 2022; 12:22210. [PMID: 36564442 PMCID: PMC9789079 DOI: 10.1038/s41598-022-26679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Descemet's stripping automated endothelial keratoplasty (DSAEK) is used for treating corneal endothelial dysfunction, and the postoperative visual acuity outcome depends on the thickness of the graft. We created a simple nomogram using factors affecting the cutting thickness during graft preparation via a mechanical microkeratome system for DSAEK. This retrospective study was conducted from May 2018 through October 2022 and included donor eyes cut by automatic methods. We measured the graft thickness, cutting accuracy, and assessed ten variables with donor/cornea-related factors potentially affecting the cutting thickness. Subsequently, we created a simple nomogram. We analyzed 81 donor tissues, and the donor median age was 76 years. The mean central graft thickness was 122.2 μm, with 62% of the grafts that could be cut within the target central graft thickness range. Comparatively, donor corneas from those with cardiac diseases were cut deeper (P = 0.007). The developed nomogram provided a 83% probability of estimating the post-cutting graft thickness within 25 µm. Our nomogram, which considers cause of death, enables reproducible production of graft of a desired thickness. A detailed analysis of donor tissues, including the cause of donor death and the characteristics from pressurization to cutting, will enable more precise DSAEK graft preparation.
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Yeu E, Gomes JAP, Ayres BD, Chan CC, Gupta PK, Beckman KA, Farid M, Holland EJ, Kim T, Starr CE, Mah FS. Posterior lamellar keratoplasty: techniques, outcomes, and recent advances. J Cataract Refract Surg 2021; 47:1345-1359. [PMID: 33769774 DOI: 10.1097/j.jcrs.0000000000000634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
Abstract
Over the past 2 decades, posterior lamellar keratoplasty (PLK) has emerged as an alternative to penetrating keratoplasty in the treatment of corneal endothelial disorders. The reasons for this trend include the search for a safer procedure to replace diseased endothelium that provides faster and better visual rehabilitation and reduces the need for postoperative care. Different surgical techniques, surgical instruments, devices, and lasers have been introduced to overcome technical difficulties, thus improving clinical outcomes. Yet, surgeons and eye banks must address the complications and limitations that arise during the transition to these new techniques. This review discusses the most significant aspects of the evolution of PLK, including a detailed description of current techniques and the direction of future treatment for corneal endothelial disease with the use of laser-assisted surgery, bioengineered corneas, cell therapy, and new pharmacologic therapy.
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Affiliation(s)
- Elizabeth Yeu
- From the Eastern Virginia Medical School and Virgina Eye Consultants, Norfolk, Virginia (Yeu); Department of Ophthalmology, UNIFESP/EPM and Instituto Suel Abujamra, Sao Paulo, Brazil (Gomes); Wills Eye Hospital, Philadelphia, Pennsylvania (Ayres); University of Toronto, Ontario, and the Eye Bank of Canada, Ontario Division, Ontario, Canada (Chan); Duke Eye Center, Durham, North Carolina (Gupta); Comprehensive Eyecare of Central Ohio, Westerville (Beckman); Department of Ophthalmology, Ohio State University, Columbus (Beckman); Gavin Herbert Eye Institute, University of California, Irvine (Farid); Department of Ophthalmology, University of Cincinnati, and Cincinnati Eye Institute, Cincinnati, Ohio (Holland); Duke Eye Center and Duke University School of Medicine, Durham, North Carolina (Kim); Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York (Starr); Scripps Clinic Medical Group, La Jolla, California (Mah)
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Ruzza A, Parekh M, Avoni L, Wojcik G, Ferrari S, Desneux L, Ponzin D, Levis HJ, Romano V. Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study. Graefes Arch Clin Exp Ophthalmol 2021; 259:1871-1877. [PMID: 33907884 DOI: 10.1007/s00417-021-05194-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the impact of establishing and maintaining a high intracameral pressure (ICP) of 200 mmHg on UT-DSAEK graft preparation using an artificial anterior chamber pressuriser (ACP) control unit (Moria SA, Antony, France). METHOD Retrospective laboratory and clinical study. Four paired donor corneas were mounted on an artificial anterior chamber and subjected to 70 mmHg ("low") and 200 mmHg ("high") ICP using an ACP system. The central corneal thinning rate was measured after 5 min using AS-OCT and the endothelial cell viability was analysed using trypan blue and live/dead staining following 70 mmHg and 200 mmHg ICP. Visual outcomes and complications in a clinical case series of nine patients with bullous keratopathy who underwent UT-DSAEK using 200 mmHg ICP during graft preparation are reported. RESULTS Laboratory outcomes showed 2 ± 1% and 2 ± 2% dead cells following 70 mmHg and 200 mmHg ICP respectively. Percentage viability in the 70 mmHg group (52.94 ± 5.88%) was not found to be significantly different (p = 0.7) compared to the 200 mmHg group (59.14 ± 10.43%). The mean corneal thinning rate after applying 200 mmHg ICP was 27 ± 13 μm/min centrally (7.2%/min). In the clinical case series, two cases were combined with cataract surgery. Re-bubbling rate was 11%. At the last follow-up (259 ± 109 days), graft thickness was 83 ± 22 μm centrally, endothelial cell density was 1175 ± 566 cell/mm2 and the BCVA of 0.08 ± 0.12 logMAR was recorded with no episodes of rejection. CONCLUSION ACP control unit for UT-DSAEK graft preparation helps in consistently obtaining UT-DSAEK grafts without compromising endothelial cell viability.
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Affiliation(s)
- Alessandro Ruzza
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy.
| | - Mohit Parekh
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
- Institute of Ophthalmology, University College London, London, UK
| | - Luca Avoni
- Unita Operativa Oculistica Di Ravenna, Azienda USL Della Romagna, Emilia Romagna, Italy
| | - Gabriela Wojcik
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
| | - Stefano Ferrari
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
| | | | - Diego Ponzin
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
- Department of Ophthalmology, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain
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Single-Pass Mikrokeratome and Anterior Chamber Pressurizer for the Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty Graft Preparation. Cornea 2021; 40:755-763. [PMID: 33630814 DOI: 10.1097/ico.0000000000002607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the reliability of microkeratome dissection with the anterior chamber pressurizer (ACP) system versus conventional pressurization for ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK) graft preparation. METHODS A retrospective review of a consecutive series of dissected donor corneas processed at Pavia Eye Bank for UT-DSAEK surgery was performed. Grafts were prepared through single-pass microkeratome dissection with artificial anterior chamber internal pressure regulation through either ACP or the conventional method using a water column with tube clamp. The target central graft thickness (CGT) was ≤100 μm. Cutting predictability was determined as the difference between the microkeratome head size and the thickness actually removed. Graft regularity was investigated as central-to-peripheral thickness increase, central-to-peripheral (CP) ratio, and graft thickness uniformity. Thickness was measured with anterior segment optical coherence tomography (horizontal and vertical meridians). RESULTS Of the 265 UT-DSAEK grafts, ACP achieved the target "CGT ≤ 100 μm" in 87 of 120 (72.5%), whereas the conventional technique achieved the same in 85 of 145 (58.6%) (P = 0.018). ACP predictability was -3.9 μm (SD: 2.3), whereas predictability of the conventional technique was -54.6 μm (SD: 3.7) (P < 0.001). Thickness increased similarly (P = 0.212); CP ratio was better with ACP for only 2 mm diameter (P = 0.001); graft thickness uniformity was comparable (P > 0.05). CONCLUSIONS Compared with conventional pressurization, ACP improved microkeratome-assisted preparation reliability of UT-DSAEK grafts, achieving CGT ≤ 100 μm with significantly higher frequency (P = 0.018) and predictability (P < 0.001). ACP improved CP ratio only at 2 mm (P = 0.001); for other graft thickness, the 2 methods proved equivalent.
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Yaguchi S, Bissen-Miyajima H, Ota Y, Oki S, Minami K. Efficacy of Femtosecond Laser-Assisted Capsulotomy: Experimental Evaluation Using the Zonular Dehiscence Model. Transl Vis Sci Technol 2020; 9:7. [PMID: 33344051 PMCID: PMC7718805 DOI: 10.1167/tvst.9.13.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this study was to evaluate experimentally the efficacy of femtosecond laser (FL)-assisted capsulotomy using an eye model with different degrees of zonular dehiscence (ZD). Methods An eye model with ZD was created by removing the total iris and including the planned range of the ZD in porcine and human cadaver eyes. FL-assisted capsulotomies (laser group) and manual capsulotomies (manual group) were created for the eye model with 0, 45, 135, 180, and 270 degrees of ZD. The continuity, mean diameter, ellipticity, and decentration of the capsulotomy were evaluated using the captured images. The same evaluation of FL-assisted capsulotomies was done for five human cadaver eyes with 180 degrees of ZD. Results In the laser group, no differences were seen in the mean diameter, ellipticity, and decentration, although the manual group resulted in significantly larger, ovalized, and decentered capsulotomies with different degrees of ZD (P < 0.001, P < 0.001, and P = 0.0317, respectively). Continuous capsulotomies or capsulotomies with microadhesions were obtained up to 180 degrees of ZD, and incomplete treatment areas were seen in eyes with 270 degrees of ZD. Capsulotomy of the human cadaver eyes with 180 degrees of ZD showed similar results to those of porcine eyes. Conclusions In this experimental study, FL-assisted capsulotomy showed favorable results in eyes with between 0 and 180 degrees of ZD compared to conventional manual capsulotomy. Translational Relevance Our experimental model can simulate the capsulotomy in cases with ZD, the results are useful when determining the indication for FL-assisted capsulotomies.
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Affiliation(s)
- Saori Yaguchi
- Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | | | - Yuka Ota
- Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | - Shinichi Oki
- Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | - Keiichiro Minami
- Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
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