Association between graft storage time and donor age with endothelial cell density and graft adherence after Descemet membrane endothelial keratoplasty

Importance After retrospectively evaluating the clinical outcome of 500 consecutive cases after Descemet membrane endothelial keratoplasty (DMEK), we extended the analysis in this study by assessing the effect of donor-related parameters on endothelial cell density (ECD) decline and detachment rate in this group. Observations This retrospective case series included 500 cases who had undergone DMEK from October 2007 to September 2012 at the Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands. Logistic regression analysis (n = 332 eyes) showed that donor age might be associated with a 3% increase in the risk for a detachment (odds ratio, 0.97; 95% CI, 0.94-1.00; P = .049) (ie, higher donor age seems to be associated with lower chances of a detachment). In addition, linear regression analysis indicated that graft storage time in medium was associated with ECD decrease (ie, the longer the storage time, the larger the decrease at 6 months after DMEK) (P = .01). Conclusions and Relevance We showed an association between graft storage time and ECD decline after DMEK and possibly between donor age and graft detachment. Therefore, donor storage times should be kept as short as possible to improve short-term ECDs. More research is needed to draw definite conclusions on the possible effect of donor age on the chance of a detachment after DMEK

Attentional Bias for Pain and Sex, and Automatic Appraisals of Sexual Penetration: Differential Patterns in Dyspareunia vs Vaginismus?

GynecologyCervix cance

Therapist-Aided Exposure for Women with Lifelong Vaginismus: Mediators of Treatment Outcome: A Randomized Waiting List Control Trial

Cervix cance

Preclinical testing of small diameter Descemet membrane endothelial keratoplasty grafts to increase tissue availability

In this study, we describe a process of preparing, surgically manipulating, and validating a novel "small diameter" 4mm circular Descemet membrane endothelial keratoplasty (DMEK) graft in vitro. Three small diameter DMEK grafts can be prepared from a single donor endothelium and could, therefore, potentially expand the donor pool. Prior to clinical use, however, we aimed to examine each step of the process to determine the effect on the endothelial cell loss and whether or not cells retained their capacity to migrate uniformly. For this study, circular small diameter grafts, obtained from twelve corneas of ten donors deemed ineligible for transplantation, were included. Small diameter DMEK graft preparation was successful in all cases (n = 36). Endothelial cell density (ECD), determined in the eye bank on seventeen grafts, showed an average decrease from 2413 (+/- 189) cells/mm(2) before to 2240 (+/- 413) cells/mm(2) after preparation. Twenty-four grafts were used to simulate DMEK-surgery in vitro and were successfully stained with 0.06% trypan blue, loaded into a straight DMEK-injector, unfolded, positioned, and centered within the circular similar to 4mm descemetorhexis. The estimated % area populated by viable cells on the grafts decreased from on average 92 (+/- 3) % before to 78 (+/- 10) % (n = 4) after in vitro surgery. Cells displayed a capacity for uniform cell migration from all edges of the graft (n = 4) when embedded in the 3D hydrogel system. Our data show, that by using an in vitro model of DMEK-surgery it was possible to test the 4mm circular DMEK grafts from eye bank preparation to surgical implantation. The cell loss after in vitro surgery was comparable with the in vivo ECD decline early after DMEK and the capacity of the cells to migrate to potentially cover bare stroma indicates that these small diameter grafts may be a viable clinical option to treat central endothelial disease.Ophthalmic researc

Phacoemulsification After Descemet Membrane Endothelial Keratoplasty: Incidence and Influence on Endothelial Cell Density

PURPOSE: To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemutsification after DMEK on the donor endothelial cell density (ECD).METHODS: The clinical data of phakic patients with DMEK were examined. From this cohort, all patients who subsequently underwent phacoemutsification after DMEK were reviewed. Data from a prospectively collected dataset were analyzed, including demographic profile, ECD, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and complications.RESULTS: From a series of 261 phakic patients with DMEK, 35 eyes (13.4%) required cataract surgery within the mean follow-up period of 54.2 +/- 28 months. The mean time from DMEK to phacoemutsification was 18 +/- 13 months (range: 3 69 months). The probability of cataract extraction after DMEK was 0.06 (95% CI: 0.03 to 0.09) at 1 year and 0.17 (95% CI: 0.12 to 0.22) at 10 years, respectively. ECD decreased from 1,314 +/- 524 cells/mm(2) before phacoemulsification to 1,167 +/- 443 cells/mm(2) (-11%) at 1 to 6 months postoperatively (P = .333). CDVA improved from 0.27 +/- 0.13 tog MAR preoperatively to 0.07 +/- 0.12 logMAR at 1 to 6 months postoperatively. CCT before phacoemulsification was 532 +/- 46 mu m and remained stable at 539 +/- 56 mu m at 1 to 6 months after phacoemulsification. Phacoemulsification did not elicit DMEK graft detachment in any of the eyes studied.CONCLUSIONS: The incidence and 10-year projection of cataract extraction in phakic eyes with DMEK was relatively tow. Phacoemulsification after DMEK provided excellent CDVA outcomes, did not induce graft detachment, and was associated with an acceptable decrease in ECD.Ophthalmic researc

Phacoemulsification after descemet membrane endothelial keratoplasty : incidence and influence on endothelial cell density

PURPOSE: To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemutsification after DMEK on the donor endothelial cell density (ECD).METHODS: The clinical data of phakic patients with DMEK were examined. From this cohort, all patients who subsequently underwent phacoemutsification after DMEK were reviewed. Data from a prospectively collected dataset were analyzed, including demographic profile, ECD, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and complications.RESULTS: From a series of 261 phakic patients with DMEK, 35 eyes (13.4%) required cataract surgery within the mean follow-up period of 54.2 +/- 28 months. The mean time from DMEK to phacoemutsification was 18 +/- 13 months (range: 3 69 months). The probability of cataract extraction after DMEK was 0.06 (95% CI: 0.03 to 0.09) at 1 year and 0.17 (95% CI: 0.12 to 0.22) at 10 years, respectively. ECD decreased from 1,314 +/- 524 cells/mm(2) before phacoemulsification to 1,167 +/- 443 cells/mm(2) (-11%) at 1 to 6 months postoperatively (P = .333). CDVA improved from 0.27 +/- 0.13 tog MAR preoperatively to 0.07 +/- 0.12 logMAR at 1 to 6 months postoperatively. CCT before phacoemulsification was 532 +/- 46 mu m and remained stable at 539 +/- 56 mu m at 1 to 6 months after phacoemulsification. Phacoemulsification did not elicit DMEK graft detachment in any of the eyes studied.CONCLUSIONS: The incidence and 10-year projection of cataract extraction in phakic eyes with DMEK was relatively tow. Phacoemulsification after DMEK provided excellent CDVA outcomes, did not induce graft detachment, and was associated with an acceptable decrease in ECD.Ophthalmic researc