Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty

Vital staining of the endothelial graft is essential during Descemet’s membrane endothelial keratoplasty (DMEK) to ensure surgical success. DMEK surgeons worldwide commonly use trypan blue (TB) to this end. However, TB may exert toxic effects on both the cornea and retina. Recently, Brilliant Blue G (BBG) has become recognized as an alternative stain for use during vitreoretinal surgery; BBG is associated with lower levels of toxicity. We retrospectively analyzed the utility of BBG staining during DMEK. We used 0.1% (w/v) BBG to stain the DMEK grafts of 12 patients. We evaluated the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) before and 3 and 6 months after surgery. BBG was effective in terms of graft visualization during DMEK. The BSCVA (log  MAR) improved from 0.99±0.57 to 0.01±0.07 (p<0.05). The CCT decreased from 720.3±58.1 μm preoperatively to 511.5±50.6 μm at 6 months postoperatively (p=0.0001). The ECD decreased from 2,754±296 cells/mm2 to 1,708±426 cells/mm2 at 6 months postoperatively (p<0.001). The ECD loss was 37.9±16.3%. The outcomes using BBG were comparable to those of earlier reports that employed TB; thus, BBG may be a viable alternative to TB

Topographic characteristics after Descemet's membrane endothelial keratoplasty and Descemet's stripping automated endothelial keratoplasty.

To investigate the topographic characteristics of the posterior corneal surface after Descemet's endothelial membrane keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) and their effects on postoperative visual acuity.Nineteen eyes of 19 patients after DMEK, 23 eyes of 23 patients after DSAEK, and 18 eyes of 18 control subjects were retrospectively analyzed. Best spectacle-corrected visual acuity (BSCVA), aberration factors (higher-order aberrations [HOAs], spherical aberrations [SAs], and coma aberrations [Comas] at 6.0 mm) were evaluated preoperatively and at 1, 3, and 6 months postoperatively. The posterior refractive pattern of the topography map was classified into 5 grades (0-5) (posterior color grade) using anterior segment optical coherence tomography. Correlations between BSCVA and some factors (abbreviation factors, posterior color grade) were analyzed.BSCVA was significantly better after DMEK than after DSAEK (P < 0.001). Posterior HOAs, SAs, and Comas after each type of endothelial keratoplasty were significantly greater compared to control (P < 0.01). Posterior HOAs, total/anterior/posterior SAs, and posterior color grade were significantly lower in the DMEK group than in the DSAEK group at 3 months (P < 0.024 [posterior HOAs], P = 0.047 [total SA], P < 0.001 [anterior SAs], P = 0.021 [posterior SAs], and P < 0.001 [posterior color grade]) and 6 months postoperatively (P = 0.034 [posterior HOAs], P < 0.001 [total SAs], P < 0.001 [anterior SAs], P = 0.013 [posterior SAs], and P = 0.004 [posterior color grade]). BSCVA was significantly correlated with HOAs, SAs, and posterior color grade (P < 0.001 for all except anterior HOAs [P = 0.004]).High posterior color grades were associated with larger aberration factors and had a negative effect on visual function after endothelial keratoplasty. Rapid improvement of visual function after DMEK may be attributed to less change at the posterior surface

Outcomes of Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes with Sutured Posterior Chamber Intraocular Lens

Purpose. To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) for vitrectomized eyes that underwent pars plana vitrectomy (PPV) and transscleral-sutured intraocular lens (IOL) implantation. Methods. In this retrospective study, DMEK cases were reviewed from medical records and divided into two groups: the eyes after PPV and transscleral-sutured IOL implantation (vitrectomized group) and the eyes with in-the-bag IOL implantation (control group) prior to DMEK. The main outcome measures included time of graft unfolding during surgery and best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, and 6 months after the DMEK. Results. Twenty-three eyes (vitrectomized group, n=8; control group, n=15) in 23 patients were included in this study. The unfolding time was significantly longer in the vitrectomized group than in the control group (P<0.001). Postoperative BSCVA was worse in the vitrectomized group (0.16 ± 0.15) than in the control group (−0.06 ± 0.06; P=0.017). The improvement in BSCVA was negatively correlated with the patients’ age and frequency of previous surgeries. Conclusions. Despite the longer graft unfolding time and limited visual recovery, DMEK should be applicable to vitrectomized eyes with transscleral-sutured IOL implantation

Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

Background The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes. Methods In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm(2)), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. Results This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 +/- 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 +/- 0.66 logMAR preoperatively to 0.78 +/- 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 +/- 238 cells/mm(2)preoperatively to 1132 +/- 323 cells/mm(2)(p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 +/- 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 +/- 3.2 D and 0.29 +/- 2.18 D, respectively. Conclusion The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery

A patient with poor visual acuity and high posterior color grade 3 months after DMEK.

<p>(A) Slit-lamp photograph shows high transparency 3 months after DMEK. (B) Pachymetry after DMEK shows that the central corneal thickness is about 480 μm, which is considerably thinner than a healthy cornea. (C) Posterior map using AS-OCT after DMEK. Three months postoperatively, AS-OCT shows rapid improvement in corneal edema after DMEK. However, despite the clear cornea after DMEK, the visual acuity is 20/40. In this case, the posterior color grade is relatively high (grade 2). The figure demonstrates the characteristically irregular topography and increased irregular astigmatism at the posterior corneal surface in eyes with relatively poor visual acuity after DMEK. Abbreviations: AS-OCT, anterior segment optical coherence tomography; DMEK, Descemet’s endothelial membrane keratoplasty.</p

Representative cases of slit-lamp microscopy and AS-OCT after endothelial keratoplasty.

<p>(A) Slit-lamp photograph 6 months after DMEK. (B) Slit-lamp photograph 6 months after DSAEK. (C) AS-OCT section 6 months after DMEK. (D) AS-OCT section 6 months after DSAEK. (E) Posterior map using AS-OCT 6 months after DMEK. (F) Posterior map using AS-OCT 6 months after DSAEK. Postoperatively, a DMEK eye is difficult to distinguish from a normal eye after cataract surgery (A). However, we can see the scarring edge of the DSAEK graft (B). An AS-OCT section shows the natural posterior curvature in the DMEK eye (C), whereas the DSAEK eye has a meniscus-shaped posterior protrusion in the central cornea (D). The posterior color is cool in the DMEK eye (E), but red in the central cornea of the DSAEK eye (F). The arrows show the virtual peripheral edges of the DMEK and DSAEK grafts. Abbreviations: AS-OCT, anterior segment optical coherence tomography; DMEK, Descemet’s endothelial membrane keratoplasty; DSAEK, Descemet’s stripping automated endothelial keratoplasty.</p

Correlations between visual acuity, HOAs, and posterior color grades.

<p>Correlations between visual acuity, HOAs, and posterior color grades.</p

Comparison of BSCVA between DMEK and DSAEK.

<p>A statistically significant improvement in BSCVA is obtained in each group (<i>P</i> < 0.001, Wilcoxon rank sum test). There is also a statistically significant difference in BSCVA between the two groups at all postoperative examinations (*<i>P</i> = 0.020, **<i>P</i> < 0.001, and **<i>P</i> < 0.001 at 1, 3, and 6 months, respectively; Mann–Whitney <i>U</i> test). Abbreviations: BSCVA, best spectacle-corrected visual acuity; DMEK, Descemet’s endothelial membrane keratoplasty; DSAEK, Descemet’s stripping automated endothelial keratoplasty.</p

Patient demographic and clinical characteristics before surgery.

<p>Patient demographic and clinical characteristics before surgery.</p