Descemet membrane endothelial keratoplasty: early results in endothelial diseases

Purpose The aim of the study was to evaluate the intraoperative complications and clinical outcome of descemet membrane endothelial keratoplasty (DMEK) in eyes with endothelial diseases. Design The study was designed as a prospective noncomparative interventional trial. Patients and methods In 13 eyes with visually significant endothelial diseases, the diseased endothelium and descemet′s membrane were stripped and replaced with a donor graft consisting of endothelium and descemet′s membrane. Intraoperative and postoperative complications were evaluated. Best spectacle corrected visual acuity, subjective and objective refraction, keratometric readings, endothelial cell density, and central corneal thickness at 3 months were documented. Results Seventeen DMEK procedures were performed. Reinjection of air into the anterior chamber was needed in nine eyes and the procedure failed in five eyes, requiring a repeat DMEK. Three months postoperatively all eyes showed a mean best spectacle corrected visual acuity of 0.36 ± 0.28 log MAR, a mean keratometric reading of 44.7 ± 1.7 D, a mean astigmatism of 2.16 ± 1.04 D, a mean endothelial cell density of 1881.71 ± 213.39 cells/mm 2 , and a mean central corneal thickness of 501 ± 27.52 μm. Conclusion Although many challenges exist when performing DMEK, this technique allows a quick and complete restoration of the visual potential in patients with corneal endothelial disorders

Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome

Purpose. The study aimed at evaluating the patients’ characteristics, risk factors, complications, and visual outcome of traumatic wound dehiscence after keratoplasty. Patients and Methods. A retrospective case series that included 20 eyes of 20 patients who had undergone a previous keratoplasty procedure followed by traumatic wound dehiscence. Records of the selected patients were reviewed. The mean duration of follow-up after repair was 21 months. Included patients were recalled for the final follow-up visit. Results. The procedure of corneal transplantation was penetrating (PKP) in 16 eyes and deep anterior lamellar keratoplasty (DALK) in 4 eyes. The associated anterior segment injuries included iris prolapse in 17 eyes and lens extrusion in 12 eyes. The associated posterior segment injuries included vitreous hemorrhage in 11 eyes and retinal detachment in 4 eyes. The final BSCVA was 0.1 or better in 5 cases (25 %) and was better than hand motions (HM) to less than 0.1 in 7 cases (35 %). Conclusion. Traumatic wound dehiscence following keratoplasty results in poor visual outcome. Cases following DALK may have less wound extent and better final visual outcome. The dehiscence seems most likely to occur during the first year

Comparison of Endothelial Cell Loss following the Big Bubble versus the Microbubble Incision Technique during Deep Anterior Lamellar Keratoplasty in Eyes with Keratoconus

Introduction. Deep anterior lamellar keratoplasty (DALK) is now becoming an increasingly popular surgical technique in treating corneal stromal pathologies with healthy endothelium. Several advantages of DALK over penetrating keratoplasty (PKP) have been described such as maintenance of globe integrity, absence of endothelial rejection, and a low rate of chronic endothelial cell loss (ECL). ECL following PKP results in 50% cell loss after 2 years from the estimated graft endothelial cell density (ECD). Although there are several reports confirming that ECL following DALK is similar to the physiologic cell loss 2 years after surgery, few reports discussed the surgically induced ECL due to difficulty in preoperative imaging of ECD. Materials and Methods. This prospective, interventional study included 20 eyes of 20 patients, who underwent DALK surgery. 11 eyes underwent DALK using the big bubble technique, while 9 eyes underwent the microbubble technique. Postoperative evaluation was done 3 months after surgery and included best spectacle corrected visual acuity (BSCVA), keratometric readings, and refraction measured using an autokeratorefractometer (Topcon KR800, Japan) and endothelial cell density (ECD) using noncontact specular microscopy (Nidek CEM-530, Japan). Results. Regarding postoperative parameters such as postoperative logMAR visual acuity, postoperative mean K, and postoperative K max, there was no statistical difference found between both groups (P=0.754, P=0.119, and P=0.970, respectively). Regarding change in specular endothelial cell density and percent change in the specular endothelial cell density, again there was no statistical difference between both groups with P=0.057 and P=0.126, respectively (significance defined as P<0.05). Conclusion. ECD is not affected by failure of the big bubble to form and continuing DALK via the microbubble technique