Descemet's Membrane Research Articles

Donor Characteristics in Graft Detachment after Posterior Lamellar Keratoplasty for Fuchs Endothelial Dystrophy and Bullous Keratopathy.

Background: Descemet Membrane Endothelial Keratoplasty (DMEK) has been widely adopted to treat Fuchs endothelial dystrophy (FED) and Bullous keratopathy (BK). Graft detachment (GD) is one of the common earliest post-operatory complications, and it is usually recovered by Air Rebubbling (ARB). Methods: Retrospectively, we investigated predictive factors related to GD between January 2016 and March 2020, a pre-COVID era, in 72 patients, 72 eyes, and their donors' lamellar characteristics, focusing on donor's cause of death. The patients were divided according to the posterior lamellar keratoplasty technique adopted. Results: GD and consequent ARB were most common but not significantly prevalent in DMEK (p = 0.11). It was more common in FED for both surgical approaches. Only in BK treated with DSAEK were host steeper mean astigmatism (p = 0.03) and donors with smaller graft pre-cut diameters (p = 0.02) less likely to be related to GD. Regarding donor's cause of death, only cardiovascular accident could be related to GD in BK treated with DMEK (p = 0.04). Conclusions: Our study shows that the conventional match between pathology and corneal lenticule is not sufficient to prevent ARB. Donor's cause of death can impair graft and host attachment. In particular, cardiovascular death may impair the efficiency of donors' endothelial cells, inducing GD after DMEK in BK.

Applications of Imaging Technologies in Fuchs Endothelial Corneal Dystrophy: A Narrative Literature Review.

Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. Moreover, FECD is associated with alterations in all corneal layers, such as thickening of the Descemet membrane, stromal scarring, subepithelial fibrosis, and the formation of epithelial bullae. Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. The application of novel technologies, including image processing technology and artificial intelligence, that are expected to further enhance the accuracy, precision, and speed of the imaging technologies will also be discussed.

Corset suture: A novel technique of overlay appositional continuous sutures with air tamponade for management of large acute corneal hydrops.

Management of large acute corneal hydrops (ACH) has always been a challenge. Various medical and surgical management options have been used, such as topical steroids, cycloplegics, antiglaucoma medications, antibiotics, Descemet's membrane reposition, and pre-Descematic sutures, for the management of acute hydrops, but have shown limited benefit. We hereby describe a novel technique of appositional continuous overlay sutures along with air tamponade for surgical management of corneal edema following large ACH. In this technique, the epithelium is scraped to visualize the stromal cleft, and then corneal marking is done to locate the suture placement site. Next, a continuous overlay, 10-0 nylon suture is passed in a crisscross fashion, just like the laces of a corset. A small paracentesis is made to lower the intraocular pressure. Stromal fluid is milked out using two iris spatulas, simultaneous suture tension adjustment is done, and the knot is secured. Appropriate anterior chamber tamponade is achieved using air, paracentesis is hydrated, and a bandage contact lens is applied. We noted complete resolution of corneal edema within 2 weeks of the procedure, with significant improvement in visual acuity.

PCR testing for herpesviruses in aqueous humor samples from patients with and without clinical corneal endothelial graft rejection.

To compare prevalence of positive PCR tests for herpesviruses between patients with and without a history of clinical corneal endothelial allograft rejection (AGR). Retrospective cross-sectional study with two-group comparison. A total of 307 aqueous humor (AH) samples from 235 Patients and 244 eyes who underwent penetrating keratoplasty or Descemet membrane endothelial keratoplasty or had a diagnostic AH aspiration due to clinical AGR between 2019 and 2023 were tested for DNA of herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV). PCR test results were compared between the two groups (with/without AGR). Another sub-analysis examined the results of patients without a history of herpetic keratitis. A total of 8% of eyes with clinical AGR (9/108) had a positive PCR result for one of the herpesviruses (HSV:3, CMV:3, EBV:2, VZV:1). All patients in the group without AGR had negative PCR results for all previous viruses (0/136). The difference was statistically significant (p < 0.001). The sub-analysis of eyes without a history of herpetic keratitis also revealed significantly more positive herpes PCR results (7/87) in eyes with AGR than in eyes without AGR (0/42, p = 0.005). Clinical AGR after keratoplasty shows a significant correlation to viral replication. Herpetic infection and AGR could occur simultaneously and act synergistically. Timely differentiation between active herpetic infection and/or AGR is pivotal for proper treatment and graft preservation.

Influence of Donor Factors on Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Preparation Outcome.

To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery. Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors' previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting. Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p<0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009). Several cardiovascular diseases (p-values between <0.001 and p=0.038), DMel type II, chronic kidney disease and previous cataract-surgery were associated with peripheral adherences (p=0.004; p=0.020 and p<0.001 respectively). Furthermore, pseudophakic donor eyes presented a higher degree of fragility of the graft (p<0.001). Age was a significant risk factor for difficult preparation (p<0.001). The staining of the graft was poorer in donors with chronic kidney disease (p=0.037). Donor diabetes mellitus type 2, heart failure, previous cataract surgery, chronic kidney disease and age are associated with a difficult DMEK graft preparation. For every one-year increment in donor age, the odds of having very difficult preparation were increased by 3%. Also, chronic kidney disease predisposes to a poor tissue staining with trypan blue during preparation.

Qualitative Blade Topology in Donor Cornea Punches and Corresponding Endothelial Cell Loss in PK and DMEK Grafts

Purpose: Two commonly used donor cornea punches were assessed using quantification of peripheral endothelial cell loss (ECL) and scanning electron microscopy (SEM) of blade topology and associated features on donor grafts. Methods: Penetrating keratoplasty (PK) (n = 8 pairs) and Descemet membrane endothelial keratoplasty (DMEK) (n = 8 pairs) grafts were prepared from mate donor corneas using Moria Busin or Corza Barron donor cornea punches (all punches were 7.5 mm) and analyzed for global and peripheral ECL. Punches were examined by SEM and subsequently used to prepare PK grafts from mate donor corneas (n = 3 pairs) that were also assessed by SEM. Results: For PK grafts, peripheral ECL caused by Busin and Barron punches was 4.2% ± 0.6% and 4.0% ± 0.9% (P = 0.62), respectively. For DMEK grafts, peripheral ECL caused by Busin and Barron punches was 3.6% ± 1.9% and 3.0% ± 1.3% (P = 0.48), respectively. SEM analysis of the Busin punch identified a rolled blade with a seam; the Barron punch is created from full rod stock and is seamless. Busin punch PK grafts have a ridge of stromal tissue that was not observed in the Barron PK grafts. Both punches exhibit anomalies along the blade edge, and the stroma of both grafts exhibited “drag lines.” Conclusions: Both punches caused similar and minimal ECL. In PK grafts, the seam of the Busin punch may be the source of the observed uneven stromal surface. Striations and debris on the cutting surfaces of both punches may produce drag lines in cut stroma. These topological features may contribute to uneven donor–recipient tissue apposition, leading to astigmatism after PK.

Validation of preloaded DMEK donor tissues: a laboratory-based study on endothelial cell viability and comparison of two F-mark inks

ObjectiveTo investigate endothelial cell loss (ECL) associated with Descemet membrane endothelial keratoplasty (DMEK) donor tissues preloaded in the DMEK RAPID transport system after 1 and 5 days and to compare prestamping with 2 different F-mark inks. MethodsDMEK donor tissues were stripped, marked with gentian violet dye applied as an F-mark, trephined, stained with trypan blue, and then preloaded into the DMEK RAPID transport system by an eye bank technician. Preloaded DMEK tissues were then unfolded and stained with calcein AM after 1 or 5 days of storage. Tissues were imaged, analyzed for total tissue ECL, and immunostained for corneal endothelium markers zonular occludens-1 and xCD166. Additionally, ECL and the intensity of an F-mark caused by 2 different inks were quantified. ResultsPreloaded DMEK tissues displayed an average ECL of 11.9% ± 4.5% (n = 8) at 1 day and 9.9% ± 4.2% (n = 9) at 5 days. No difference was found between the 2 groups. Zonular occludens-1 and activated leukocyte cell adhesion molecule (ALCAM; also know as CD166) staining showed that the corneal endothelial monolayer remained intact on preloaded tissues. On 5-day preloaded DMEK tissues, the average ECL and mean grayscale caused by the Keir Surgical ink F-mark and the Cardinal Health ink F-mark were 4.3% ± 0.8% and 158.5 ± 13.9% and 5.0% ± 1.1% and 142.9% ± 20.0%, respectively. No difference was found between the F-mark inks. ConclusionPreloaded DMEK donor tissues resulted in an acceptable ECL range after 1 and 5 days of storage and were deemed suitable for transplantation. Both F-mark inks are acceptable for prestamping preloaded DMEK tissues prior to surgical transplantation with comparable ECL and intensities.

Topical Insulin Treatment for Neurotrophic Corneal Ulcer with Persistent Epithelial Defect

Background: Neurotrophic keratitis (NK) is a degenerative corneal disease caused by impairment of corneal sensory innervation. It is characterized by decreased or absent corneal sensation, leading to epithelial breakdown, impairment of healing, and ultimately to the development of corneal ulceration, melting, and perforation. We described a case of neurotrophic ulcer with persistent epithelial defect and its remarkable healing response to insulin eye drop treatment. Case Presentation: A 62-year-old male patient was referred to our hospital for the management of stage III NK in the left eye. The condition started 6 months ago; the patient developed a sudden onset of left eye diminution of vision, red eye, and tearing. The patient sought an ophthalmic consultation and was diagnosed with herpes simplex keratitis. On examination, visual acuity OS was hand motion (HM), severe conjunctival injection, deep corneal vascularization, corneal opacity with stromal infiltration, epithelial defect about 3.5 x 6 mm, stromal thinning, Descemet membrane folds and loss of corneal sensation by cotton wisp test. The patient was treated with topical insulin eye drops for 6 weeks and showed substantial ulcer healing and reepithelization of the epithelial defect. Conclusion: Insulin drops have been shown to substantially promote persistent epithelial defect healing in the case of neurotrophic ulcers. Therefore, topical insulin use can potentially help in the treatment of refractory neurotrophic keratitis. Further studies with large case numbers and long follow-ups should be the main focus of future research.

Relationship of posterior peripheral corneal layers and the trabecular meshwork: an immunohistological and anatomical study

Background/AimWith the popularity of endothelial keratoplasty (EK) procedures, Descemet membrane (DM) EK and pre-Descemet EK, considerable work has been done on understanding the posterior corneal anatomy. Most of the information...

Outcomes of phaco-trabeculectomy versus phaco-viscocanalostomy for primary open angle glaucoma

PurposeThis study aimed to compare the intraocular pressure (IOP)-lowering effect and postoperative adverse effects of combined phacoemulsification and trabeculectomy (PT) and combined phacoemulsification and viscocanalostomy (PVC) in eyes with primary open-angle glaucoma (POAG). MethodsIn this prospective study, eighty-one consecutive patients (81 eyes) with POAG and cataract were enrolled. The eyes were randomly assigned to either the PT group (40 eyes) or the PVC group (41 eyes). The main outcomes included the success rate based on IOP and the evaluation of adverse effects during the 6-month follow-up period. The surgery was considered a complete success if the IOP was between 6 and 20 mmHg and reduced by ≥30% without glaucoma medications or additional surgery compared to the preoperative level. A qualified success was characterized by an IOP within the range of 6−20 mmHg and a 20−30% reduction in IOP achieved through the use of glaucoma medications. ResultsThe mean baseline IOP was 23.20 ± 7.94 mmHg in the PT group and 21.29 ± 6.81 mmHg in the PVC group (P = 0.249). At 6 months, the mean postoperative IOP in the PT and PVC groups were 13.50 ± 2.49, and 13.73 ± 1.70, respectively. There was no significant difference in mean IOP between the groups at any time (P > 0.05). At 6 months, 22 patients (55%) in the PT group and 22 patients (53.66%) in the PVC group achieved complete success. Nine eyes (22.50%) in the PT group and 10 eyes (24.39%) in the PVC group achieved qualified success. The other patients (9 eyes in each group) did not meet the criteria for at least a qualified success and were considered failures (P = 0.980). Intraoperative microperforation of Descemet's membrane occurred in 2 cases (15%) in the PVC group. Postoperative complications included 4 cases (10%) of shallow/flat anterior chamber, 1 case (2.5%) of choroidal effusion, and 1 case (2.5%) of aqueous misdirection in the PT group. The rate of these postoperative adverse effects was not significant between the two groups (P > 0.05). ConclusionsThere was no significant difference in IOP reduction between PT and PVC in patients with POAG. Furthermore, PVC is safe enough in these patients, compared to PT.

Differences in Guttae Ultramorphology in Relation to Visual Function in Fuchs Endothelial Corneal Dystrophy.

The purpose of this study was to investigate the differences in guttae ultramorphology and their relation to visual function in eyes with Fuchs endothelial corneal dystrophy (FECD). Thirty FECD eyes without ocular comorbidities were included. Visual functional parameters (best-corrected visual acuity with high-contrast and low-contrast letters and contrast sensitivity/LogCS) and corneal morphology measured with Scheimpflug tomography (Pentacam) were assessed. The surgically removed Descemet membranes were examined by light and transmission electron microscopy. Preoperative mean best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.52 ± 0.18, LogCS 0.96 ± 0.21 and central corneal thickness 640 ± 55 μm. All eyes had signs of subclinical corneal edema in Scheimpflug tomography; clinically visible corneal edema was present in 40% of eyes. Histological findings included a posterior fibrillar zone (PFZ) in 10 specimens (33%) and abnormal collagen depositions in Descemet membranes in 14 specimens (47%). Guttae buried within the PFZ were present only in eyes with clinically visible edema (n = 4, 13%). There was no difference in visual function results and tomography parameters between eyes with and without PFZ or between protruding guttae and guttae embedded in a PFZ, respectively. Guttae morphology and density were not correlated with visual functional parameters. Guttae buried in a PFZ occurred only in eyes with clinically manifest edema, and thereby, they are an ultramorphological sign for advanced FECD. Subclinical edema was present in all eyes and might be more relevant for quality of vision than guttae ultramorphology.

Corneal Endothelium Viability Assay Using Trypan Blue Dye After Preloaded Descemet Membrane Endothelial Keratoplasty Graft Preparation.

The purpose of this study was to establish a validated method, consistent with Eye Bank Association of America medical standards, for evaluating endothelial cell loss (ECL) from an entire Descemet membrane endothelial keratoplasty (DMEK) graft using trypan blue dye as an alternative to specular microscopy. Twenty-nine corneas were prepared for preloaded DMEK by a single technician, and the endothelium was stained with trypan blue dye for 30 seconds. The technician estimated total cell loss as a percentage of the graft and captured an image. Images were evaluated by a blinded technician using ImageJ software to determine ECL and compared with endothelial cell density from specular microscopy. Tissue processing intervals were analyzed for 4 months before and after implementation of this method. For the 29 grafts, there was no statistically significant difference ( t test, P = 0.285) between ECL estimated by a processor (mean = 5.8%) and ECL calculated using an ImageJ software (mean = 5.1%). The processor tended to estimate greater ECL than the actual ECL determined by ImageJ (paired t test, P = 0.022). Comparatively, postprocessing endothelial cell density measured by specular microscopy were higher compared with the preprocessing endothelial cell density (mean = 4.5% P = 0.0006). After implementation of this evaluation method, DMEK graft processing time intervals were reduced by 47.9% compared with specular microscopy evaluation ( P < 0.001). Our results show that visual ECL estimation using trypan blue staining by a DMEK graft processor is a reliable and efficient method for endothelial assessment. Unlike specular microscopy, this method achieves comprehensive visualization of the entire endothelium, reduces total time out of cold storage, and decreases total time required to prepare and evaluate DMEK grafts.

Descemet’s membrane tears following forceps delivery

: To report a case series on corneal trauma induced by forceps assisted vaginal delivery.: Case records of six patients who had clinical features suggestive of corneal trauma induced by forceps delivery were retrospectively reviewed and analysed. Vertical to oblique corneal Descemet’s membrane (DM) tears were noted in all 6 patients which included 2 males and 4 females. Right eye was involved in all patients and one patient had bilateral involvement. The age of presentation ranged from 5 to 39 years. Three patients had visual acuity better than 6/18 and three had worse than 6/18 in their affected eyes. All patients had corneal astigmatism in the range of 1.75 to 8 diopters. : A complicated vaginal delivery should be anticipated at the earliest by the obstetrician and an apt decision on the mode of delivery has to be attempted in order to prevent avoidable ocular trauma, especially in forceps assisted vaginal deliveries. All neonates who are born by forceps assisted vaginal delivery require mandatory referral to an ophthalmologist to rule out any ocular trauma. Early intervention can prevent irreversible vision loss due to amblyopia.

Interactions of Corneal Endothelial Cells with Stromal Cells during Corneal Endothelial Injury

Purpose: To investigate the interaction of corneal endothelial cells (CECs) with corneal stromal cells (CSCs) on the healing of chemically induced corneal endothelial injury.Methods: Twenty-five rabbits were divided into two groups: rabbits exposed to NaOH and controls. Rabbits were clinically evaluated and sacrificed at 1 day, 1 week, 2 weeks, and 4 weeks after endothelial injury. Corneal endothelial cells and corneal stromal cells were cultured and the wound healing rate of the corneal endothelium and cytokines in the culture medium were analyzed with and without co-culture in the Transwell system.Results: Corneal edema and opacity scores were higher in all rabbits exposed to NaOH than in controls. Corneal endothelial apoptosis with little effect on CSCs was observed in rabbits exposed to NaOH at day 1. Two weeks after injury, CECs migrated from the periphery. CSCs were aligned in parallel to Descemet's membrane, which exhibited the presence of CECs. Transforming factor-β1 and interleukin-6 secretion was lower in the co-culture system than in individual cultures of CECs or CSCs.Conclusions: These results revealed intracameral NaOH injection is a model of corneal endothelial injury with minimal impact on the stroma. Communication between CECs and CSCs during wound healing may lead to the modulation of cytokine production, which is necessary for an enhanced healing process of corneal endothelial injury.

Fuchs endothelial corneal dystrophy: an updated review.

The present review will summarize FECD-associated genes and pathophysiology, diagnosis, current therapeutic approaches, and future treatment perspectives. Literature review. Fuchs' endothelial corneal dystrophy (FECD) is the most common bilateral corneal dystrophy and accounts for one-third of all corneal transplants performed in the US. FECD is caused by a combination of genetic and non-heritable factors, and there are two types: early-onset FECD, which affects individuals from an early age and is usually more severe, and late-onset FECD, which is more common and typically manifests around the age of 40. The hallmark findings of FECD include progressive loss of corneal endothelial cells and the formation of focal excrescences (guttae) on the Descemet membrane. These pathophysiological changes result in progressive endothelial dysfunction, leading to a decrease in visual acuity and blindness in later stages. The present review will summarize FECD-associated genes and pathophysiology, diagnosis, current therapeutic approaches, and future treatment perspectives. With the characterization and understanding of FECD-related genes and ongoing research into regenerative therapies for corneal endothelium, we can hope to see more significant improvements in the future in the management and care of the disease.

Chinese expert consensus on corneal endothelial transplantation (2024)

Endothelial keratoplasty (EK) is an effective therapy for corneal endothelial diseases and mainly includes Descemet stripping endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Compared with penetrating keratoplasty, EK has better vision rehabilitation and a lower rate of allograft rejection after surgery. However, EK poses a series of technical challenges, and varied complications may occur intraoperatively and postoperatively. A successful EK surgery depends on the standardized technical manipulations and the management of surgical complications. In order to standardize the surgical procedure of EK in China, the Cornea Group of Ophthalmology Branch of Chinese Medical Association has made a comprehensive discussion about indications of surgery, preoperative evaluation, surgical manipulations, and the management of complications based on the literature available thus far and clinical practice in China, and eventually established this consensus, which may guide corneal surgeons in performing the EK surgery.

Intraocular pressure-related side-effects after endothelial keratoplasty.

To investigate circumpapillary retinal nerve fibre layer (RNFL) thickness, pupillary function and diameter after phacoemulsification and lens implantation alone or combined with endothelial keratoplasty (EK). This study was a secondary analysis of data from a randomized, single-masked trial, that included 72 patients with Fuchs' endothelial dystrophy and cataract, equally allocated (1:1) to ultrathin Descemet's stripping automated endothelial keratoplasty or Descemet's membrane endothelial keratoplasty. The cataract extraction (CE) group included 40 patients undergoing cataract surgery only. All patients were treated with phacoemulsification and lens implantation. RNFL thickness was significantly lower in the CE group than after EK for the global (p < 0.01), nasal (p = 0.04), and temporal sectors (p = 0.01) 12 months after surgery. RNFL thickness was comparable between patients treated with rebubbling and others (p ≥ 0.16 for all comparisons) after 12 months. The CE group and patients treated with EK demonstrated a comparable scotopic (p = 0.34) and photopic pupil diameter (p = 0.95) as well as a comparable maximum (p = 0.83) and average pupillary constriction velocity (p = 0.95) after 12 months. In contrast, patients treated with rebubbling had a significantly smaller scotopic pupil diameter (p = 0.04). In this study, no evidence was found indicating a negative impact on the RNFL thickness after EK when compared to CE 12 months after surgery. Iris function and pupil diameter were comparable between the CE group and patients treated with EK after 12 months.

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.

Predictive factors for re-bubbling after DMEK: focus on the posterior corneal surface.

To understand whether the preoperative morphology of the posterior corneal surface influences the rate of re-bubbling after Descemet membrane endothelial keratoplasty (DMEK). After retrospectively analyzing the medical records of patients undergoing DMEK, in this multicentric cross-sectional study, we performed a binomial logistic regression analysis to assess significant predictors of re-bubbling and re-transplantation after surgery. Analyzed parameters included the preoperative diagnosis, anterior and posterior surface K1/K2, central corneal thickness, posterior Q value, and other posterior corneal surface parameters evaluated on the elevation maps produced by anterior segment optical coherence tomography. Results were stratified based on the surgeons' experience. We included 202 eyes of 202 patients with a mean age of 69.5 ± 12.4years; 154 eyes were operated by a high-volume surgeon and 48 by one with less experience; 48 eyes (23.8%) underwent 1 re-bubbling and 14(6.9%) 1 re-transplantation. The presence of positive/less-negative posterior corneal irregularities and irregularities with greater absolute height had a significantly higher risk of re-bubbling in both the expert and less expert group (OR = 2.85 and 1.42, OR = 3.22 and 3.01, respectively, p < 0.05), whereas more negative posterior K1 and K2 were significant risk factors only in the former group (OR = 0.67 and 0.55, respectively, p < 0.05). Endothelial decompensation other than Fuchs and pseudophakic bullous keratopathy, more negative posterior Q values and smaller distances between center, and the highest/lowest posterior corneal surface irregularity correlated with an increased risk of graft failure (OR 1.23, 1.21, and 1.29, respectively, p < 0.05). Posterior corneal surface morphology significantly influences the risk of re-bubbling after DMEK.

Risk factors for early graft detachment requiring rebubbling in Descemet membrane endothelial keratoplasty with imported pre-cut donor tissues.

Graft detachment is a common and significant complication in Descemet membrane endothelial keratoplasty (DMEK). We investigated the risk factors of graft detachment requiring rebubbling after DMEK using imported pre-cut donor tissues. The medical records of 48 patients who underwent DMEK for Fuchs' endothelial dystrophy (FED) or bullous keratopathy (BK) at Seoul National University Hospital were retrospectively reviewed. Donor, recipient, and surgical factors were evaluated using univariate and multivariate logistic regression models. Graft detachment requiring rebubbling occurred in 17 (32.7%) eyes. The detachment group exhibited older recipient age (p = 0.006), higher prevalence of diabetes (p = 0.001), and a higher proportion of FED (65%, p = 0.003). Notably, the detachment group demonstrated a significantly lower postoperative 2-h intraocular pressure (IOP) (p = 0.002) and a greater proportion of eyes with IOP <20 mmHg (p < 0.001). Older recipient age (OR 1.08, 95% CI 1.02-1.17), diabetes (OR 23.8, 95% CI 2.61-217), FED surgical indication (OR 6.19, 95% CI 1.74-22.0), lower postoperative 2-h IOP (OR 1.21, 95% CI 1.06-1.38), and postoperative 2-h IOP <20 mmHg (OR 14.0, 95% CI 1.64-119) were associated with increased odds of graft detachment. According to multivariate logistic regression, lower postoperative 2-h IOP (OR 1.23, 95% CI 1.02-1.47) and postoperative 2-h IOP <20 mmHg (OR 25.1, 95% CI 1.05-602) increased the risk of graft detachment. Lower postoperative 2-h IOP, particularly below 20 mmHg, may increase the risk of graft detachment, and diabetes in recipients may pose a higher risk of graft detachment after DMEK.