Descemet Stripping Automated Endothelial Keratoplasty Research Articles

Refractive outcomes following cataract combined with lamellar keratoplasty: femtosecond-DSEK versus microkeratome-DSAEK.

Prediction of postoperative refraction following posterior lamellar keratoplasty is crucial for choosing proper intraocular lens power in combined surgeries. Femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK) creates thin, planar grafts while microkeratome-assisted Descemet's stripping automated endothelial keratoplasty (DSAEK) creates non-planar, concaved grafts. We evaluated whether this fundamental difference affects the refractive outcomes in cataract surgery combined with FS-DSEK compared to cataract surgery combined with microkeratome-assisted DSAEK. A retrospective analysis of 28 patients who underwent FS-DSEK combined with phacoemulsification and intraocular lens (IOL) implantation (group A) compared to 26 patients who underwent microkeratome-assisted DSAEK combined with phacoemulsification and IOL implantation (group B). Pre- and 1-year postoperative best-corrected visual acuity (BCVA), keratometry values, corneal thickness, central-to-peripheral graft thickness ratio (C/P ratio), and target postoperative spherical equivalent (SE) versus actual postoperative SE were analyzed. Target postoperative SE and actual postoperative SE significantly shifted toward hyperopia in group B, but not in group A. Postoperative hyperopic shifts were 0.14D and 1.13D in groups A and B, respectively (P < 0.001). BCVA improved after surgery in both groups, with no significant difference between the groups. Postoperative C/P ratio differed significantly between the groups and was negatively correlated with postoperative hyperopic shift (r = - 0.616, P < 0.001). Refractive outcomes of cataract surgery combined with FS-DSEK are relatively neutral, whereas those of cataract surgery combined with microkeratome-assisted DSAEK cause significant hyperopic shift. Clinicians should select accordingly an appropriate intraocular lens power when performing these surgeries.

Xen Gel Stent as a minimally invasive option for intraocular pressure control after DSAEK: A case study.

This case study describes the implantation of a Xen45 Gel Stent in a patient that had previously undergone Descemet stripping automated endothelial keratoplasty (DSAEK). Glaucoma might worsen after corneal transplant, and while medical treatment is the first-line therapy to achieve intraocular pressure (IOP) control, a surgical approach is required when medication does not reach the target IOP. In 2017, the patient underwent treatment in both eyes with ocular hypotensive eye drops for pseudoexfoliative (PXF) glaucoma. In May 2017, DSAEK was performed on the right eye because of the presence of a pseudophakic bullous keratopathy. An increase in IOP, resistant to medical treatment, was observed after the corneal transplant. In November 2017, a Xen45 Gel Stent was implanted. The patient had a positive outcome with a Xen45 Gel Stent implant in surgical glaucoma treatment after DSAEK. The case demonstrated excellent postoperative IOP control, stable vision and a healthy ocular graft at short-term and long-term follow-ups. Studies with larger numbers of patients in this particular form of therapy are required. Nevertheless, Xen45 Gel Stent implantation appears to be a promising option in preventing or limiting glaucoma in patients who have previously undergone DSAEK. It is a brief, minimally invasive procedure with reduced postoperative inflammation, faster visual recovery and a lower risk of graft damage or hypotony, even in the case of PXF glaucoma.

Eye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty Lenticules.

To report the management of precut Descemet stripping automated endothelial keratoplasty (DSAEK) lenticules unsuitable for transplantation because of irregular anterior profile after microkeratome cutting. After preparation for DSAEK, 20 tissues were considered unsuitable for transplantation because of nonhomogeneous posterior stromal thickness. To convert them into suitable tissues for surgery, manual stromal delamination was performed by removing the excess stromal layers after the indications obtained through optical coherence tomography. These tissues were further transplanted as ultrathin DSAEK. Nineteen tissues were delaminated successfully. The average reduction in thickness in the center (63 ± 69 μm; P = 0.0101) and periphery (129 ± 39 μm; P < 0.0001) before and after delamination was significantly different. One tissue showed signs of perforation during manual dissection and therefore considered unsuitable for transplantation. Primary graft failure was reported in one case, but it was not correlated with the tissue preparation. No other clinical complications were observed after surgery. Manual delamination of the stroma because of irregular microkeratome cutting is a viable option to obtain a uniform graft thickness required for DSAEK surgeries. This technique can further reduce tissue wastage that is observed after microkeratome cutting errors.

Exophiala lecanii-corni keratitis presenting as a serpiginous pigmented superficial lesion: a case report

Rationale:Patients with bullous keratopathy (BK) treated by Descemet stripping automated endothelial keratoplasty (DSAEK) have a compromised cornea, due to the administration of topical steroid, postsurgical use of contact lenses, and impaired barrier function of the corneal epithelium by BK. We report a case of Exophiala lecanii-corni (E lecanii-corni) keratitis presenting as a serpiginous pigmented superficial lesion after DSAEK.Patient concerns:An 81-year-old woman who had undergone cataract surgeries, suffered from decreased vision in the left eye. She was diagnosed BK and she underwent DSAEK. Two months after DSAEK, a pigmented superficial lesion developed on the left cornea. The lesion migrated and recurred repeatedly and she was referred to our department. Best corrected vision was 20/220.Diagnoses:Light microscopy of a corneal scraping revealed branching fungal hyphae. Fungal culture showed growth of a black colony, identified as E lecanii-corni by ribosomal DNA sequencing.Interventions:We started topical treatment with 1% voriconazole and 1.5% levofloxacin. Antifungal susceptibility testing showed that the minimum inhibitory concentration of voriconazole was 0.06 μg/mL.Outcomes:The lesion scarred after treatment for 3 months, and left best corrected vision improved to 20/40.Lessons:Genus Exophiala is known as 1 of the “black molds” and a cause of chromomycosis. This is the first description of E lecanii-corni keratitis, and pigmented corneal epithelial lesions may be characteristic of this fungal genus.

Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty

AimTo assess the influence of graft thickness and regularity on visual recovery and postoperative wavefront aberrations after endothelial keratoplasty (EK).Methods150 EKs performed in eyes with corneal endothelial disorders and no...

Clinicopathologic Correlations of Retrocorneal Membranes Associated With Endothelial Corneal Graft Failure

To provide clinicopathologic correlations for retrocorneal membranes associated with Descemet stripping automated endothelial keratoplasty (DSAEK) failure. Retrospective case series. The specimens and medical records of the patients diagnosed with clinically significant retrocorneal membranes associated with DSAEK failure at the Bascom Palmer Eye Institute or the University of Miami Veterans Hospital between October 2015 and March 2020 were reviewed for demographics, clinical presentation, comorbidities, and surgeries performed. Histopathologic analysis was performed on hematoxylin-eosin and periodic acid-Schiff sections. Immunohistochemical studies were performed for smooth muscle actin (α-SMA), pancytokeratin, and CK7. Immunofluorescence was performed for vimentin, N-cadherin, ROCK1, RhoA, ZEB1, and Snail. A total of 7 patients (3 male and 4 female) were identified to have a clinically significant retrocorneal membranes at the time of graft failure. The average age at the time of first DSAEK was 70 years (range: 55-85 years). All patients were pseudophakic and had a glaucoma drainage device in place; 1 had a history of failed DSAEK. Ranging from 0 to 47months after surgery, a variably thick retrocorneal fibrous membrane was observed, eventually leading to graft failure. Four patients underwent subsequent penetrating keratoplasty and 3 underwent repeat DSAEK. On histopathologic evaluation, a pigmented fibrocellular tissue was identified along the posterior margin of the corneas and DSAEK buttons in all cases. Further characterization with immunohistochemistry and immunofluorescence demonstrated membranes to be negative for pancytokeratin and positive for α-SMA, vimentin, CK7, N-cadherin, ZEB1, Snail, ROCK1, and RhoA. Fibrocellular retrocorneal membrane proliferation may be associated with DSAEK failure in patients with previous glaucoma drainage device surgery. Our results demonstrate myofibroblastic differentiation and a lack of epithelial differentiation. Positivity for markers of an endothelial-to-mesenchymal transition indicates possible endothelial origin and could be the hallmark for future targeted pharmacotherapy.

Long-term results of Descemet-stripping automated endothelial keratoplasty for endothelial failure caused by phakic intraocular lenses.

To describe the surgical approach and long-term outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to phakic intraocular lenses (pIOL). Retrospective, interventional case series of 18 eyes of 13 patients who developed endothelial failure secondary to pIOL implant. Patients were submitted to pIOL explant and DSAEK for visual rehabilitation, with or without phacoemulsification plus posterior-chamber intraocular lens implant. The minimum follow-up time was 3 years and the main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and percentage of endothelial cell loss (ECL), intraoperative and postoperative complications. Patients' mean age was 47.44 (7.86) years with a mean follow-up time of 55.61 (14.13) months. Sixteen eyes (88.9%) had an angle-supported pIOL. The mean pIOL implant-to explant time was 8.17 (2.73) years. BCVA improved from 1.00 (0.36) logMAR preoperatively to 0.29 (0.36) logMAR at 1 year of follow-up (p < 0.001), remaining stable over the entire follow-up period (p > 0.05). At the last visit, all corneas were clear, with a mean ECD of 724.74 (325.57) cells/mm2. During the follow-up, two eyes (11.1%) required a re-DSAEK due to early graft failure (<3 months). Our outcomes reveal that an individualized and careful approach may result in a stable visual rehabilitation in young patients with corneal decompensation following pIOL implant.

Incidence and Management of Cystoid Macular Edema after Corneal Transplantation

In this review, we overview the incidence and management of cystoid macular edema following endothelial keratoplasty (EK) including Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Incidence of CME was 2.0–12.7% following DSAEK and 0.7–15.6% following DMEK. Glaucomatous eyes, in particular, with primary angle closure glaucoma and eyes with severe iris damage and eyes with combined EK with transscleral intraocular lens implantation experienced postoperative CME at a higher incidence. Topical non-steroidal anti-inflammatory (NSAIDs) and intensive topical steroid can effectively treat and prevent CME recurrences. CME is one of the major complications following EK and can be involved in the limitation of the recovery of postoperative visual acuity. Careful attention should be paid to patients with systemic and ocular conditions, as these might trigger postoperative CME. The prophylactic use of NSAIDs and intensive steroid treatment may be a reasonable approach.

An endothelial rejection line following Descemet stripping automated endothelial keratoplasty

BackgroundThe endothelial rejection line is rarely seen after Descemet stripping automated endothelial keratoplasties (DSAEKs). Here, we present a case of endothelial graft rejection with an endothelial rejection line occurring 1 year after the procedure.Case presentationA 58-year-old female presented with graft rejection 1 year following a DSAEK procedure. The episode started when she tapered down her loteprednol to once a day. Slit-lamp examination showed a mildly injected conjunctiva with 1+ corneal oedema. On the posterior surface of the cornea, there was an endothelial rejection line (Khodadoust line) with keratic precipitates and multiple areas of anterior synechia.ConclusionThe classic endothelial rejection line should be kept in mind as a rare sign of DSAEK graft rejection.

Graft survival and endothelial outcomes after penetrating keratoplasty and Descemet stripping automated endothelial keratoplasty: A systematic review and meta-analysis.

The present study aimed to compare the outcomes of graft survival, endothelial cell loss and vision improvement between penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for treating corneal endothelium diseases. The PubMed, CENTRAL (Cochrane) and Embase databases were searched for records added until September 20, 2019. The studies considered were two-arm prospective and retrospective studies comparing outcomes of interest between PK and DSAEK. Ultimately, 10 studies were included with a total of 2,634 patients (910 eyes treated with DSAEK; 1,804 eyes treated with PK). Assessment of the summary effect by meta-analysis suggested that, compared with PK treatment, DSAEK was associated with a greater improvement from baseline in best spectacle-corrected visual acuity [difference (diff.) in means of change from baseline=-0.225, 95% CI=-0.341 to -0.109, P<0.001] and a reduced loss of endothelial cell density (diff. in means=-292.05 cells/mm2, 95% CI=-419.53 to -146.57 cells/mm2, P<0.001). Graft survival rates were similar using either PK or DSAEK (odds ratio=1.005, 95% CI=0.329-3.071, P=0.993). The overall results suggested that DSAEK may have an advantage over PK for corneal endothelial dysfunction in terms of the visual acuity outcome. The absence of definite time frames in the comparisons limits the conclusions on endothelial cell loss and graft survival.

Queratoplastia penetrante temprana después de queratitis fúngica de la interface en la queratoplastia endotelial de la membrana de Descemet

In this case-report we describe the first reported case of early-onset fungal interface keratitis (IK) after Descemet Membrane Endothelial Keratoplasty (DMEK) successfully treated with penetrating keratoplasty (PK) during the active stage of infection. A patient with graft failure after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was operated on with DMEK. Donor rim culture and broth were positive for Candida albicans. Several interface infiltrates were confirmed and localized using anterior segment optical coherence tomography. Three days after diagnosis, observing clear signs of intraocular infection, the graft was removed with simultaneous washed-up of anterior chamber with fluconazole 1% followed by a PK and intrastromal corneal injections of fluconazole. A best-corrected visual acuity of 20/20 was achieved. This case highlights the importance of analysing every donor rim and broth, despite the patient doesn’t show any symptoms or signs during the post-operative period. PK is a viable treatment option in early-onset interface keratitis.

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation in Patients with a History of Keratoplasty

Purpose To examine the surgical outcomes and graft conditions in patients receiving micropulse transscleral cyclophotocoagulation (MP-TSCPC) to treat post-keratoplasty ocular hypertension. Methods This retrospective observational study included 30 eyes of 28 consecutive glaucoma patients with a history of penetrating keratoplasty (PKP) or Descemet's stripping automated endothelial keratoplasty (DSAEK) who underwent MP-TSCPC at the University of California, San Francisco from 09/2015 to 08/2018. Using the Wilcoxon signed-rank test, we compared preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, visual acuity, and central corneal thickness at 1, 3, 6, and 12 months. Postoperative complications, additional surgeries, and graft failures were also recorded at these follow-up times. Linear regression model was used to study whether PKP vs. DSAEK affects the effectiveness of MP-TSCPC. Results Thirty eyes from 28 patients were followed for 12 months. IOP was significantly decreased from preop at all follow-up points (P < 0.001). There was no significant change in the number of glaucoma drops, visual acuity, or CCT. At 12 months, 21 of the 30 eyes met the definition of success, and only one underwent repeat PKP due to graft rejection. The type of corneal transplant was not a significant factor for IOP reduction at the last follow-up. Conclusions MP-TSCPC achieved desirable IOP control and success rates for postkeratoplasty patients while resulting in minimal complications and graft failure. It appears to be a safe and effective procedure in patients who received corneal transplant with one-year follow-up.

Visibility of the Retina Through an Air-Filled Anterior Chamber During Simultaneous Vitrectomy and Descemet's Stripping Automated Endothelial Keratoplasty.

PurposeTo describe the visibility of the retina through an air-filled anterior chamber during simultaneous pars plana vitrectomy (PPV) and Descemet’s stripping automated endothelial keratoplasty (DSAEK), and to discuss the technical challenges of a fluid-air exchange under such conditions.MethodsSix eyes from 6 patients with coexisting bullous keratopathy and posterior segment problems such as vitreous opacity, retained silicon oil, intraocular lens subluxation, or aphakia underwent simultaneous PPV and DSAEK. In all cases, after completion of 25-gauge PPV with/without flanged intrascleral intraocular lens fixation, DSAEK donor tissue was inserted into the anterior chamber. Air was then injected into the anterior chamber to attach the donor graft to the back surface of the host cornea. At this point, the visibility of the retina was evaluated using endoillumination and a wide-angle viewing system.ResultsIn all cases, visibility of the retina through an air-filled anterior chamber, with the DSAEK donor attached, was sufficient to perform a fluid-air exchange.ConclusionOur clinical observations of such rare but clinically important conditions indicate that simultaneous PPV and DSAEK is possible with fair visualization of the posterior segment including the retina.

Femtolaser-assisted keratoplasty: Surgical outcomes and benefits

Femtosecond laser technology has evolved as an alternative method to make surgical incisions in keratoplasty. The use of this approach has a number of purported advantages that may lead to superior clinical outcomes. However, there remains a low uptake of the femtolaser-assisted keratoplasty within public healthcare, and incongruity remains between perceived expert opinion on the presence and significance of superior clinical outcomes based on available data. This review is registered publicly on the Open Science Framework registry and aims to evaluate the evidence base on femtolaser-assisted keratoplasty and its comparison with manual trephination in intraoperative and postoperative outcomes. Over 2000 studies were screened and critically appraised in the field of keratoplasty, using multiple databases. 17 studies were included via predetermined criteria for full analysis. The studies covered interventional research into penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and posterior lamellar keratoplasty (PLK). The results of this review show that PK studies shared a trend of improved visual outcomes with the femtolaser, and evidence for earlier suture removal. Complication rates were similar. When used for DALK, studies showed some evidence of improved visual outcomes with the femtolaser, and evidence for earlier suture removal, reduced intraoperative complications and increased wound healing activity. The use in Descemet’s membrane endothelial keratoplasty (DMEK) showed reduced graft detachment whereas in Descemet’s stripping automated endothelial keratoplasty (DSAEK) the results were limited. Overall, this review shows a trend that the use of the femtolaser may improve clinical outcomes in PK, DALK and DMEK. However, it was also clear that in order to corroborate the superiority of femtolaser-assisted keratoplasty versus manual methods, further research is required.

A 27-Year Report from the Central Eye Bank of Iran.

PurposeTo report the 27-year statistical data from the Central Eye Bank of Iran (CEBI) and its activity.MethodsAll CEBI records regarding procured eyes, tissue utilizations, corneal transplants per capita, and indications for keratoplasty from 1991 to 2017 were analyzed.ResultsIn total, 115,743 whole eyes were donated during the 27-year period. Out of the 114,169 eyes donated between 1994 and 2017, 95,314 eyes were distributed for transplantation, and 95,057 corneas were actually transplanted. The mean annual rate of corneal transplants per capita was 55.10 27.10. Although penetrating keratoplasty (PKP, 70%) was the most common technique of corneal transplantation during the study period, it exhibited a decreasing trend between 2006 and 2017 (P = 0.048). It was in contrast to Descemet stripping automated endothelial keratoplasty (DSAEK) that demonstrated an increasing trend during the same period (P 0.001). Keratoconus (KCN, 39.70%) was the most leading indication for keratoplasty over the last three decades followed by bullous keratopathy (BK, 18.5%), corneal scar and opacities (15.7%), and graft failure (GF, 7.5%), with an increasing trend for BK, GF, and KCN. A majority of scleral tissues (83.7%) were utilized for orbital implant protection.ConclusionAn increasing trend in the number of procured eyes was observed over the past 27 years in Iran. The most leading indications for corneal transplantation were KCN and BK. While PKP was the most common keratoplasty technique, DSAEK showed an increasing trend over the last 12 years.

Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)

Purpose: The purpose of this study to analyze the visual outcome and complications of DSAEK with their management.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Department of ophthalmology Khyber Teaching Hospital Peshawar, from January 2017 to April 2019.&#x0D; Material and Methods: Twenty-one patients were selected by convenient sampling method from the outpatient department of Khyber Teaching Hospital Peshawar. Informed written consent was obtained from all patients. Ethical approval of the study was obtained from institutional review board (IRB) of Khyber Medical College, in accordance with the declaration of Helsinki. All cases of DSAEK were performed by a single surgeon. We received the precut DSAEK tissue and then endoglide was used in 5 (23.8%) and Busin Glide in 16 (76.19%) of cases. The unfolding of the donor tissue was performed by preplaced anterior chamber maintainer using balance salt solution. Any complication either intra operative or post operative, which happened, were recorded and managed either medically, or by appropriate surgical means.&#x0D; Results: The average visual acuity before surgery was CF-1m. After DSAEK procedure, average best-corrected visual acuity was 6/36. Per-operative complications included incomplete stripping of the Descemet membrane and loss of donor button during mounting in glide. Complications in the early post-operative period were pupillary block glaucoma in 3 eyes and donor tissue dislocation in 2eyes. Late post-operative complications included edema and non-attachment after re-bubbling, late secondary glaucoma, cystoids macular edema (CME) and interface opacification.&#x0D; Conclusion: DSAEK is a promising alternative in corneal endothelial de-compensation to penetrating Keratoplasty.

Resolution of Corneal Fibrosis After Descemet’s Stripping Automated Endothelial Keratoplasty: A Case Report

PurposeTo report the resolution of anterior corneal fibrosis after Descemet’s stripping automated endothelial keratoplasty (DSAEK), in a patient with chronic corneal edema and anterior stromal scarring.MethodsA 63-year-old woman, with a history of Fuchs endothelial dystrophy, presented with increasing discomfort and gradual visual loss in her right eye. Clinical examination revealed long-standing bullous keratopathy accompanied by marked subepithelial fibrosis (SEF). Based on the low postoperative visual potential due to glaucomatous optic neuropathy, we decided to proceed with DSAEK.ResultsDuring the follow-up period, SEF was found to gradually resolve. Corneal clarity was restored and an improvement in visual acuity was observed up to 12 months after surgery.ConclusionDSAEK alone may represent an effective therapeutic option for the restoration of impaired corneal clarity in patients with long-standing corneal edema and concomitant anterior subepithelial scarring.

Predicting the likelihood of need for future keratoplasty intervention using artificial intelligence

ObjectiveTo apply artificial intelligence (AI) for automated identification of corneal condition and prediction of the likelihood of need for future keratoplasty intervention from optical coherence tomography (OCT)-based corneal parameters. DesignCohort study. ParticipantsWe collected 12,242 corneal OCT images from 3162 subjects using CASIA OCT Imaging Systems (Tomey, Japan). We included 3318 measurements collected at the baseline visit of each patient. A total of 333 eyes had post-operative penetrating keratoplasty (PKP), lamellar keratoplasty (LKP), deep anterior keratoplasty (DALK), descemet's stripping automated endothelial keratoplasty (DSAEK) or descemet's membrane endothelial keratoplasty (DMEK) intervention. MethodWe developed a pipeline including linear and nonlinear data transformations followed by unsupervised machine learning and applied on corneal parameters from the baseline visit of each patient. Five non-overlapping clusters of eyes were identified. Post hoc analyses revealed that clusters corresponded to different likelihoods of need for future keratoplasty. These clusters on a 2-dimensional map can be used by clinicians and surgeons to identify patients with higher risk of need for future keratoplasty intervention. Main outcome measuresThe likelihood of the need for future surgery. ResultsThe mean age of participants was 69.7 (standard deviation; SD = 16.1) and 59% were female. The normalized likelihood of need for future corneal keratoplasty intervention for eyes mapped onto clusters one to five were 2.2%, 1.0%, 33.1%, 32.7%, and 31.0%, respectively. ConclusionsThe AI system can assist the (cornea) surgeon in identifying those patients who may be at higher risk for future keratoplasty using comprehensive corneal shape, thickness, and elevation parameters. Future research utilizing independent datasets is necessary to validate the proposed system.

Influence of temperature change in donor corneas on postoperative endothelium cell density following endothelial transplantation

To examine the influence on postoperative endothelial cell density (ECD) caused by preoperative temperature change from 4 °C to room temperature in donor corneas for Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective, case-controlled comparison of 100 eyes that underwent DSAEK using imported donor corneas transferred from an overseas eye bank (SightLife, Seattle, WA, USA). Fifty donor corneas experienced temperature reversal for ECD measurement (TR group), and postoperative outcomes were compared with 50 disease-matched cases that did not experience temperature changes before DSAEK (NTR group). The main outcome measure was endothelial cell loss and reduction rate of ECD at 1, 3, and 6 months following DSAEK. ECD at 3 months following DSAEK was significantly less in the TR group (1458 ± 494/mm2) than in the NTR group (1696 ± 374/mm2; P = 0.014), though ECD at 6 months was not significantly less in the TR group. The reduction rate of ECD at 3 months was greater in the TR group (42.3% ± 17.2%) than in the NTR group (35.7% ± 14.2%; P = 0.044), though reduction rate of ECD at 6 months was not significantly less in the TR group. We found that preoperative temperature change in donor corneas may adversely affect ECD following DSAEK.

Hybrid Descemet Membrane Endothelial Keratoplasty (H-DMEK): results of a donor insertion pull-through technique using donor stroma as carrier

AimTo evaluate the outcomes and complications of hybrid Descemet membrane endothelial keratoplasty (H-DMEK) using a Descemet stripping automated endothelial keratoplasty (DSAEK) pull-through donor inserter and donor stroma as carrier.MethodsThis was...