Underwent Descemet Membrane Endothelial Keratoplasty Research Articles

Machine learning based endothelial cell image analysis of patients undergoing descemet membrane endothelial keratoplasty surgery.

In this study, we developed a machine learning approach for postoperative corneal endothelial cell images of patients who underwent Descemet's membrane keratoplasty (DMEK). An AlexNet model is proposed and validated throughout the study for endothelial cell segmentation and cell location determination. The 506 images of postoperative corneal endothelial cells were analyzed. Endothelial cell detection, segmentation, and determining of its polygonal structure were identified. The proposed model is based on the training of an R-CNN to locate endothelial cells. Next, by determining the ridges separating adjacent cells, the density and hexagonality rates of DMEK patients are calculated. The proposed method reached accuracy and F1 score rates of 86.15 % and 0.857, respectively, which indicates that it can reliably replace the manual detection of cellsin vivoconfocal microscopy (IVCM). The AUC score of 0.764 from the proposed segmentation method suggests a satisfactory outcome. A model focused on segmenting endothelial cells can be employed to assess the health of the endothelium in DMEK patients.

Long-Term Follow-Up of Descemet Stripping Only: Data Up to 7 Years Postoperatively.

The aim of this study was to report long-term follow-up of eyes undergoing Descemet stripping only (DSO). This was a retrospective study including 26 eyes of 20 patients undergoing DSO between December 2015 and November 2022. Eligibility criteria included peripheral endothelial cell count (ECC) >1000 cells/mm2 and symptoms caused by central guttata. Patients underwent a central circular 4-mm descemetorhexis using a reverse Sinskey hook and a pair of descemetorhexis forceps using a peeling technique. Three parameters were measured before surgery and at last follow-up: best-corrected visual acuity (BCVA), central corneal thickness (CCT), and ECC measured centrally and at the periphery. The mean age was 73 ± 9 years [52-90 years]. The average follow-up period was 23.7 ± 24.8 months [3-84]. Twenty-two eyes responded to DSO with 20 female eyes (91%) and 2 male eyes (9%). The mean postoperative BCVA improved from 0.3 ± 0.17 logMAR to 0.09 ± 0.13 logMAR (P value <0.05). The mean postoperative CCT decreased from 588 ± 41 μm to 546 ± 50 μm (P-value <0.05). The mean postoperative central ECC was 780 ± 257 cells/mm2 [484-1500]. Peripheral ECC decreased postoperatively (1837 ± 407 cells/mm2 preoperatively to 864 ± 340 cells/mm2 postoperatively, P value >0.05). Peripheral endothelial cell polymegathism was stable (average of 26.8% ± 6.8% preoperatively and 30.2% ± 14% postoperatively). Average peripheral endothelial cells polymorphism decreased postoperatively (63.1 ± 20.5% preoperatively to 33% ± 25% postoperatively, P value >0.05). Four eyes did not show improvement after DSO and underwent Descemet membrane endothelial keratoplasty surgery. There were 3 men (75%) and 1 women (25%). The preoperative trend was for nonresponders to have lower BCVA, higher CCT, more abnormal peripheral polymorphism, and polymegathism. The results of this study, with up to 7 years follow up, demonstrate the durability of DSO.

Surgical goniolens for tag identification and removal in DMEK surgery.

We describe a novel technique for identifying endothelial Descemet membrane (DM) tags remaining after descemetorhexis in patients undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery. A surgical goniolens is applied to the corneal surface after descemetorhexis in order to visualize the peripheral inner corneal layer at 360° and identify endothelial-DM tags. A detailed visualization of the peripheral inner corneal layer is possible using goniolens, without using any staining in the anterior chamber. The technique may be used to screen the posterior corneal surface for any retained endothelial-DM tags. It may to lower the risk of remaining tags and indirectly lower the incidence of DMEK graft detachment.

The ROCK‐inhibitor ripasudil suppresses the expression of extracellular matrix proteins in Fuchs endothelial corneal dystrophy

AbstractPurpose: Fuchs endothelial corneal dystrophy (FECD) is characterized by a progressive loss of human corneal endothelial cells (HCEC) and excess deposition of extracellular matrix (ECM). As FECD pathophysiology involves Rho‐associated kinase (ROCK) signalling activation, we investigated the effect of various ROCK inhibitors on the expression of ECM proteins and proteolytic enzymes using ex vivo and in vitro models.Methods: Endothelial cell‐Descemet membrane lamellae (DM) from donor corneas (n = 20) and FECD patients (n = 100) undergoing Descemet membrane endothelial keratoplasty were used as ex vivo model. A human corneal endothelial cell line (HCEC‐12) served as in vitro model. Rho‐ROCK signalling pathway components and the effects of the ROCK inhibitors ripasudil (10/30 μM), Y‐27632 (10/30 μM), and netarsudil (1 μM) on the expression of ECM proteins and proteolytic enzymes were analysed, with or without addition of transforming growth factor β1 (TGFβ1, 5 ng/ml), using quantitative real‐time PCR and Western Blot analysis.Results: Constitutive expression of components of the Rho‐ROCK signalling pathway was higher in DM specimens from FECD patients compared to DM from normal donors. Stimulation with all three ROCK inhibitors significantly downregulated the expression of ECM genes, such as collagen 3 alpha 1 (COL3A1) and fibronectin 1 (FN1), in both FECD and normal DM as well as in HCEC‐12, compared to untreated controls, with ripasudil showing the most significant effect. Downregulation of COL1A1 and FN1 by ripasudil was verified on protein level as well. Ripasudil also suppressed the TGFβ‐induced expression and phosphorylation of downstream molecules of the TGFβ pathway (SMAD2) as well as of the Rho‐ROCK pathway (MLC2). Ripasudil further upregulated gene expression of proteolytic enzymes, e.g. matrix metalloproteinase 1 (MMP1) and MMP3.Conclusions: These findings suggest that inhibition of ROCK signalling in FECD patients may have a beneficial effect by suppressing expression and stimulating turnover of abnormal ECM components.

Video Grading of Descemet Membrane Endothelial Keratoplasty Surgery to Identify Surgeon Risk Factors for Graft Detachment and Rebubbling: A Post Hoc Observational Analysis of the Advanced Visualization In Corneal Surgery Evaluation Trial.

The aim of this study was to explore video-graded intraoperative risk factors for graft detachment (GD) and rebubbling in Descemet membrane endothelial keratoplasty surgery. A post hoc analysis of 65 eyes of 65 pseudophakic subjects with Fuchs endothelial dystrophy that underwent Descemet membrane endothelial keratoplasty surgery as part of the Advanced Visualization In Corneal Surgery Evaluation trial. All surgical recordings were assessed by 2 graders using a structured assessment form. A multinominal regression was performed to estimate the independent effect of video-graded intraoperative factors on the incidence of GD and rebubbling. Secondary outcomes are corrected distance visual acuity and endothelial cell density. In total, 33 GDs were recorded, of which 17 required rebubbling. No significant predictors for GD or rebubbling were identified. However, the results revealed 2 clinically relevant patterns. An unfavorable graft configuration (ie, wrinkled, tight scroll, or taco-shaped) and a gas-bubble size smaller than the graft diameter were associated with an increased risk of GD [odds ratio (OR) 2.5 and OR 2.26, respectively] and rebubbling (OR 2.0 and OR 2.60, respectively). Inversely, a larger gas-bubble size was associated with a reduced risk of GD (OR 0.37) and rebubbling (OR 0.36). At 3 and 6 months postoperatively, corrected distance visual acuity was poorer in subjects requiring a rebubbling and endothelial cell density loss was higher in subjects with a partial GD. Our analysis revealed that the gas-bubble size and graft shape/geometry seem to be relevant clinical factors for GD and rebubbling, whereas descemetorhexis difficulty, degree of graft manipulation, graft overlap, and surgical iridectomy were not associated with an increased risk.

Comparison of Intraocular Pressure Measurements With Goldmann Applanation Tonometry, Tonopen XL, and Pascal Dynamic Contour Tonometry in Patients With Descemet Membrane Endothelial Keratoplasty.

IOP measured with Tonopen and DCT was higher than GAT in eyes that underwent DMEK. To compare intraocular pressure (IOP) measurements measured based on Goldmann applanation tonometry (GAT), Tonopen XL, and Pascal Dynamic Contour Tonometry (DCT) in patients who had undergone descemet membrane endothelial keratoplasty (DMEK) and to appraise the influence of central corneal thickness (CCT) on IOP measurements. Thirty-four eyes (from 34 patients) who underwent DMEK at least 1 month before the study were included. We performed Tonopen XL, GAT, and DCT IOP measurements at 10 min intervals. Bland-Altman plots were used to assess agreement between GAT, Tonopen XL, and DCT. Spearman rank correlation was used to calculate the deviation from GAT readings by each device and correlate the readings with the CCT variable. The mean IOP values with GAT, Tonopen XL, and DCT were 14.9±5.8, 16.2±5.5, and 19.2±5.0, respectively. Statistically significant differences between GAT and Tonopen XL and between GAT and DCT were noted ( r =0.942 [0.885-0.971]; P =0.0001 and r =0.942 [0.885-0.971]; P =0.0001, respectively). DCT tended to return a higher IOP relative to GAT and Tonopen XL. CCT and IOP readings obtained by GAT, Tonopen XL, and DCT did not show a statistically significant correlation with each other. IOP as measured with both Tonopen and DCT was found to be higher than GAT in eyes that underwent DMEK surgery although the techniques showed a good correlation. After DMEK surgery, all 3 measurement techniques can be practical in routine postoperative examinations, however it is recommended to measure IOP with the same device during patient follow-up.

Selective laser trabeculoplasty for steroid-induced ocular hypertension following endothelial keratoplasty.

Purpose: To examine the safety and efficacy of selective laser trabeculoplasty (SLT) in patients responding to topical steroids with elevated intraocular pressure following endothelial keratoplasty. Methods: Patients that underwent Descemet Membrane Endothelial Keratoplasty (DMEK) or Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) were offered SLT as first-line therapy if they presented with steroid response and met inclusion criteria. Patient demographics, best-corrected visual acuity (BCVA), steroid and glaucoma regimens were recorded before and after SLT. Results: Twelve eyes of 8 patients were recruited to the study. All patients demonstrated a reduction in IOP and only one patient remained on anti-glaucoma drops after SLT. The mean (±SD) reduction in IOP following SLT was 8.8 (±4.9) mmHg (p < 0.0001). BCVA remained stable and no adverse events following treatment were observed. Conclusions: SLT may be a safe and effective treatment option that reduces topical antihypertensive burden while allowing continuance of corticosteroids in steroid-responsive eyes at high risk of rejection following endothelial keratoplasty. Larger randomized studies are needed to compare SLT efficacy with topical medication in this patient group and to review any impact on graft survival and glaucoma progression.

Progressive changes in visual function after Descemet Membrane Endothelial Keratoplasty

AbstractPurposeTo compare progressive changes in visual function parameters in patients with Fuchs entothelial dystrophy (FED) who underwent Descemet Membrane Endothelial Keratoplasty (DMEK). To compare visual results after DMEK with visual function parameters in healthy subjects without corneal pathology.MethodsThirty patients (30 eyes) with FED who underwent DMEK surgery were included in the study. All subjects underwent best corrected visual acuity (BCVA) evaluation using the ETDRS optotype in photopic and scotopic conditions, and contrast sensitivity (CS) assessment using the CSV 1000 and the Pelli Robson test in different lighting conditions, preoperatively, at 1 and 6 months after surgery. Thirty eyes of 30 healthy controls were evaluated using the same protocol and compared with the patients’ final postsurgery data.ResultsA significant improvement in all visual function parameters was observed in patients 1 month (p &lt; 0.05) and 6 months (p &lt; 0.05) after DMEK, compared with preoperative levels. No significant differences were observed between patients and healthy controls in the lowest spatial frequency of 3cpd (photopic, p = 0.891; mesopic, p = 0.064; mesopic with glare, p = 0.786). Healthy controls had significantly higher BCVA in photopic and scotopic conditions (p = 0.015, p = 0.03, respectively), better CS measured with the CSV 1000 test in the spatial frequencies of 6 cpd, 12 cpd and 18 cpd and with the Pelli Robson test (p = 0.002).ConclusionsDMEK improves visual function parameters in patients with FED in the first month after surgery. Patients who underwent DMEK present similar contrast sensitivity to healthy subjects in lower frequencies. However, the rest of the values assessed were significantly lower in DMEK patients compared to healthy controls 6 months after surgery.

Scheimpflug Backscatter Imaging of the Fibrillar Layer in Fuchs Endothelial Corneal Dystrophy

Retrospective analysis of a prospective observational case series. A total of 34 eyes (34 subjects) undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery with preoperative high-quality Scheimpflug backscatter imaging data were included. The Descemet endothelium complex (DEC) was retrieved during DMEK surgery, and immunofluorescence staining was performed for collagens I, III, and IV. The FL morphology in en face Scheimpflug backscatter and immunofluorescence imaging was compared and agreement of FL parameters was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman plots. Scheimpflug backscatter imaging delineated the FL in 26 eyes and was FL negative in 8 eyes with deviation compared to immunofluorescence in 1 case and good agreement of morphology characteristics. Horizontal caliper diameter ± SD was 4.84 ± 0.85 mm, vertical caliper diameter was 3.92 ± 0.78 mm, maximum caliper diameter was 5.12 ± 0.82 mm, and surface area was 12.43 ± 4.74 mm2. Compared to immunofluorescence imaging, mean difference (95% limits of agreement) and intraclass correlation coefficients were for horizontal caliper diameter 0.13 mm (-0.81 to 1.1 mm) and 0.88, vertical caliper diameter 0.23 mm (-0.76 to 1.2 mm) and 0.81, maximum caliper diameter 0.06 mm (-1.1 to 1.2 mm) and 0.86, and surface area 1.4 mm2 (-3.9 to 6.7 mm2) and 0.85. Scheimpflug backscatter imaging facilitates visualization of the FL in advanced FECD eyes, offering the potential to identify particularly diseased areas of the FECD endothelium in vivo.

Corneal transplant survival rate in glaucoma patients with multiple previous antiglaucoma surgeries.

Glaucoma can cause corneal decompensation and accelerate the failure of the graft. Previous antiglaucoma operations are one of the most important risk factors for endothelial failure. In this retrospective study, 40 eyes of 40 glaucoma patients with advanced corneal decompensation after glaucoma surgery were treated with keratoplasty and outcomes were assessed for 24months. 16, 9 and 15 eyes underwent Descemet Membrane Endothelial Keratoplasty (DMEK), Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and penetrating keratoplasty (pKPL), respectively. Visual acuity improved at least 2 lines in 24 of 40 eyes after the three types of keratoplasty. All 40 eyes remained pain free for the follow-up period. The mean intraocular pressure (IOP) difference was not significantly different (p > 0.05) from the preoperative values 12 and 24months after keratoplasty. The endothelial cell density of the donor cornea decreased from 2485.6 ± 165.18 to 1291.4 ± 467.1 and 1180.4 ± 397.2/mm2 (p < 0.001) after 12 and 24months, respectively. Nine eyes (22.5%) had therapy-resistant corneal decompensation in the context of a transplant failure and were treated with a re-keratoplasty (2 re-pKPLs, 3 re-DSAEKs and 3 re-DMEKs). Eyes with previous glaucoma surgery show satisfying results after keratoplasty, mainly DMEK and pKPL.

Outcomes after Descemet membrane endothelial keratoplasty over a period of 7 years at a tertiary referral center: endothelial cell density, central corneal thickness, and visual acuity

PurposeTo better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)).MethodsConsecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density.ResultsPostoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p <.001; 1.15 to .87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1.ConclusionEyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.

Quality of vision and vision-related quality of life after Descemet membrane endothelial keratoplasty: a randomized clinical trial.

PurposeTo compare quality of vision and vision‐related quality of life (QOL) in patients undergoing Descemet membrane endothelial keratoplasty (DMEK) or ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK).MethodsFifty‐four eyes of 54 patients with Fuchs' dystrophy from six corneal clinics in the Netherlands were randomized to DMEK or ultrathin DSAEK and examined preoperatively, and 3, 6 and 12 months postoperatively. Main outcome measures were corneal higher‐order aberrations (HOAs), contrast sensitivity, straylight and vision‐related QOL.ResultsPosterior corneal HOAs decreased after DMEK and increased after ultrathin DSAEK (p ≤ 0.001) 3 months after surgery and correlated positively with best spectacle‐corrected visual acuity (12 months: r = 0.29, p = 0.04). Anterior and total corneal HOAs did not differ significantly between both techniques at any time point. Contrast sensitivity was better (p = 0.01), and straylight was lower (p = 0.01) 3 months after DMEK compared with ultrathin DSAEK; 95% confidence interval [CI] of log(cs) 1.10–1.35 versus 95% CI: 0.84 to 1.12, and 95% CI: log(s) 1.18 to 1.43 versus 95% CI: 1.41 to 1.66, respectively. Both were comparable at later time points. Vision‐related QOL (scale 0–100) did not differ significantly between both groups at any time point and improved significantly at 3 months (β = 12 [95% CI: 7 to 16]; p < 0.001), and subsequently between 3 and 12 months (β = 5 [95% CI: 0 to 9]; p = 0.06).ConclusionsDescemet membrane endothelial keratoplasty (DMEK) results in lower posterior corneal HOAs compared with ultrathin DSAEK. Contrast sensitivity and straylight recover faster after DMEK but reach similar levels with both techniques at 1 year. Vision‐related QOL improved significantly after surgery, but did not differ between both techniques.

The relationship between systemic disorders and anatomical outcomes after Descemet membrane endothelial keratoplasty.

The aim of this study was to investigate the association of anatomical outcomes and medications of patients with systemic diseases who underwent Descemet membrane endothelial keratoplasty with donor factors. Sixty nondiabetic donors of endothelial grafts and 60 patients who underwent operation by a single surgeon were included in this retrospective study. The patients' data, including the presence of diabetes mellitus and hypertension, antidiabetic-antihypertensive medications, and intracameral tamponades and anatomical outcomes, were recorded. The donor data were obtained from eye bank records. Eighteen patients had type 2 diabetes mellitus (30%) and 34 had hypertension (56.6%). Among the patients with diabetes mellitus, 13 were receiving a single-agent antidiabetic drug, 4 were receiving dual oral antidiabetic therapy, and 1 was receiving insulin therapy. Among the hypertensive patients, 11 had monotherapy and 23 had dual antihypertensive therapy. Postoperatively, 35 patients (58.3%) had an endothelial attachment, 8 (13.3%) received reinjection, 7 (11.7%) required re-Descemet membrane endothelial keratoplasty, and 10 (16.7%) underwent penetrating keratoplasty. The mean donor age was 51.2 ± 14.1 years. The most common cause of donor death was cardiopulmonary arrest (36/60 cases; 60.0%). Regression analysis revealed that the presence of diabetes mellitus significantly disrupted graft attachment (p=0.034), while the presence of hypertension, antidiabetic and antihypertensive medication use, and the type of tamponade used in the patients, and the age, sex, cause of death, and specular endothelial cell count of donors were not statistically significantly associated with graft attachment (p>0.05). In this study, the anatomical outcomes of Descemet membrane endothelial keratoplasty surgery were affected by recipient and donor factors. The presence of diabetes mellitus in the recipient significantly negatively affected graft attachment.

Potential Functional Restoration of Corneal Endothelial Cells in Fuchs Endothelial Corneal Dystrophy by ROCK Inhibitor (Ripasudil)

Rho-associated kinase (ROCK) inhibitors have been successfully used as a rescue strategy in eyes that failed to clear after descemetorhexis without endothelial graft for treatment of Fuchs endothelial corneal dystrophy (FECD). The functional mechanisms by which ROCK inhibitors modulate corneal endothelial cell regeneration in FECD patients have, however, not been clarified. Here, we analyzed the effect of the ROCK inhibitor ripasudil on corneal endothelial cells of FECD patients and normal donors using exvivo tissue and invitro cellular models. Experimental study: laboratory investigation. This institutional study used endothelial cell-Descemet membrane lamellae from FECD patients (n= 450) undergoing Descemet membrane endothelial keratoplasty (FECD exvivo model), normal research-grade donor corneas (n= 30) after scraping off central endothelial cells (exvivo wound healing model), normal donor corneas (n= 20) without endothelial injury, and immortalized cell lines (n= 3) generated from FECD patients (FECD invitro model). Descemet membrane lamellae were dissected into halves and incubated for 24-72 hours in storage medium with or without a single dose of 30μM ripasudil. The effects of ripasudil on expression of genes and proteins related to endothelial cell proliferation, migration, functionality, and endothelial-to-mesenchymal transition were analyzed and complemented by functional assays on FECD cell lines. A single dose of ripasudil induced significant upregulation of genes and proteins related to cell cycle progression, cell-matrix adhesion and migration, as well as endothelial barrier and pump function up to 72 hours, whereas classical markers of endothelial-to-mesenchymal transition were downregulated in both FECD and normal specimens compared to unstimulated controls exvivo. In addition to stimulation of proliferation and migration, ripasudil-induced changes in expression of functional signature genes could be also verified in FECD cell lines invitro. These data support the concept that inhibition of ROCK signaling represents a potent tool in regenerative therapies in FECD patients through reactivation of cell proliferation and migration as well as restoration of endothelial pump and barrier function without inducing adverse phenotypic changes.

Assessing the validity of corneal power estimation using conventional keratometry for intraocular lens power calculation in eyes with Fuch\u2019s dystrophy undergoing Descemet membrane endothelial keratoplasty

PurposeThe present retrospective study was designed to test the hypothesis that the postoperative posterior to preoperative anterior corneal curvature radii (PPPA) ratio in eyes with Fuch’s dystrophy undergoing Descemet membrane endothelial keratoplasty (DMEK) is significantly different to the posterior to anterior corneal curvature radii (PA) ratio in virgin eyes and therefore renders conventional keratometry (K) and the corneal power derived by it invalid for intraocular lens (IOL) power calculation.MethodsMeasurement of corneal parameters was performed using Scheimpflug imaging (Pentacam HR, Oculus, Germany). In 125 eyes with Fuch’s dystrophy undergoing DMEK, a fictitious keratometer index was calculated based on the PPPA ratio. The preoperative and postoperative keratometer indices and PA ratios were also determined. Results were compared to those obtained in a control group consisting of 125 eyes without corneal pathologies. Calculated mean ratios and keratometer indices were then used to convert the anterior corneal radius in each eye before DMEK to postoperative posterior and total corneal power. To assess the most appropriate ratio and keratometer index, predicted and measured powers were compared using Bland-Altman plots.ResultsThe PPPA ratio determined in eyes with Fuch’s dystrophy undergoing DMEK was significantly different (P < 0.001) to the PA ratio in eyes without corneal pathologies. Using the mean PA ratio (0.822) and keratometer index (1.3283), calculated with the control group data to convert the anterior corneal radius before DMEK to power, leads to a significant (P < 0.001) underestimation of postoperative posterior negative corneal power (mean difference (∆ = − 0.14D ± 0.30) and overestimation of total corneal power (∆ = − 0.45D ± 1.08). The lowest prediction errors were found using the geometric mean PPPA ratio (0.806) and corresponding keratometer index (1.3273) to predict the postoperative posterior (∆ = − 0.01 ± 0.30) and total corneal powers (∆ = − 0.32D ± 1.08).ConclusionsCorneal power estimation using conventional K for IOL power calculation is invalid in eyes with Fuch’s dystrophy undergoing DMEK. To avoid an overestimation of corneal power and minimize the risk of a postoperative hyperopic shift, conventional K for IOL power calculation should be adjusted in eyes with Fuch’s dystrophy undergoing cataract surgery combined with DMEK. The fictitious PPPA ratio and keratometer index may guide further IOL power calculation methods to achieve this.

Anatomical Changes in the Anterior Chamber Volume After Descemet Membrane Endothelial Keratoplasty

To evaluate changes in the anterior chamber of eyes that have undergone Descemet membrane endothelial keratoplasty (DMEK) and to identify factors that affect these changes. This retrospective study included 25 pseudophakic eyes of 25 patients who underwent DMEK. We determined the preoperative and postoperative values of the best spectacle-corrected visual acuity, spherical equivalent (SE), anterior chamber volume (ACV), anterior chamber depth (ACD), central corneal thickness (CCT), and scleral spur angle (SSA) evaluated using anterior segment optical coherence tomography and iris damage score and iris posterior synechiae score. We defined ∆ as the average change rate from the preoperative to postoperative value for each factor at 1 month (SE at 6-12 months) postoperatively. We also analyzed correlations between ∆ACV, ∆SE, and other preexisting factors. Compared with the preoperative ACV value (128 ± 28 mm3), the postoperative value significantly increased to 155 ± 21 mm3 (P < 0.001); ∆SE was +1.01 ± 1.09 diopters. ∆ACV was negatively correlated with preoperative ACD (R = 0.643, P < 0.001) and SSA (R = 0.555, P = 0.001) and positively correlated with ∆ACD (R = 0.799, P < 0.001) and ∆SSA (R = 0.608, P < 0.001). ∆CCT, iris damage score, and iris posterior synechiae score were not significantly correlated with ∆ACV. ∆SE was positively correlated with ∆ACV, ∆ACD, and ∆SSA (R = 0.680, 0.455, and 0.478; P < 0.001, <0.05, and <0.05, respectively). An increase in the ACV and hyperopic change was noted after successful DMEK, especially in eyes with narrow-angled shallow anterior chambers.

Descemet Stripping Only Supplemented With Topical Ripasudil for Fuchs Endothelial Dystrophy 12-Month Outcomes of the Sydney Eye Hospital Study.

To report early safety and efficacy of Descemet stripping only (DSO) supplemented with ripasudil. A pre-post clinical trial with a historical control group for time to heal and cell count parameters. The study received ethics approval and was conducted with oversight of a data safety monitoring board. All enrolled patients had a superior endothelial cell count of >1000 cells/mm2 and were symptomatic from the presence of central guttata degrading vision and/or producing glare. DSO was carried out with a peeling technique and not combined with any other intervention. Ripasudil 0.4% was applied topically from day 1 postoperatively at a dose of 6 times/d until corneal clearance. Cases with relapse of edema were permitted to restart on ripasudil at a reduced dose of 2 drops/d for a further 2 weeks. Stopping rules with progression to a corneal graft were established. Baseline ocular and systemic investigations were carried out and repeated at varying intervals to monitor for local and systemic adverse events. Twenty-three eyes of 23 patients met the inclusion criteria and underwent DSO. Twenty-two of 23 eyes achieved corneal clearance at a mean time of 4.1 weeks. In all patients achieving clearance, improvement in vision was recorded. Improvement in mean uncorrected visual acuity was 0.20 Logarithm of the minimum angle of resolution (LogMar), and improvement in mean best spectacle corrected visual acuity was 0.156 LogMar. One patient failed to clear and underwent Descemet membrane endothelial keratoplasty at week 12. Twenty-one of 22 patients achieving corneal clearance expressed satisfaction with the procedure. The commonest systemic side effect of topical ripasudil was gastrointestinal upset (24%), and the commonest local side effect was ocular irritation (43%). No patient experienced a serious adverse event in the course of the trial. Thirty-nine percent of patients experienced a relapse of edema on ceasing ripasudil, with clearance again on recommencing. This trial of DSO supplemented with ripasudil included local and systemic safety analysis. We judge that this treatment option is emerging as a reliable intervention for select patients with Fuchs' Endothelial Corneal Dystrophy (FECD) with an acceptable safety profile. The observation of relapse edema is strong evidence of a drug effect. The longevity of these results remains unknown.

Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty

To compare the long-term graft survival outcomes and complications of patients who underwent Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and penetrating keratoplasty (PK) for Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK). Retrospective comparative cohort study. Patients with FECD and BK who underwent DMEK (121 eyes), DSAEK (423 eyes), or PK (405 eyes) from the prospective cohort from the Singapore Corneal Transplant Registry were included. A Kaplan-Meier survival analysis was conducted to compare the survival probabilities of the 3 groups. The main outcome measure was graft survival. The DMEK group had the best overall cumulative graft survival of 97.4%, compared to DSAEK (78.4%) and PK (54.6%) (P < .001). In eyes with FECD, the DMEK group had the best graft survival of 98.7% compared to DSAEK (96.2%) and PK (73.5%) (P= .009). The graft survival in eyes with BK was poorer overall; however, the DMEK group still had the best graft survival of 94.7%, compared to DSAEK (65.1%) and PK (47.0%, P= .001). Eyes that underwent DMEK had the lowest rate of graft rejection (1.7% vs DSAEK 5.0% vs PK 14.1%, P < .001) and postoperative elevation of intraocular pressure (11.6% vs DSAEK 23.6% vs PK 22.5%, P= .015). Patients who underwent DMEK for FECD and BK had better graft survival compared to DSAEK and PK. Eyes that underwent DMEK also had a significantly lower rate of graft rejection and elevated intraocular pressure compared to DSAEK and PK for the same indications.

C-Press Technique to Facilitate Descemet Membrane Endothelial Keratoplasty Surgery in Vitrectomized Patients: A Case Series.

To describe an original technique to unfold the graft in vitrectomized eyes undergoing Descemet membrane endothelial keratoplasty (DMEK). We performed a retrospective chart and video review of successive cases presenting with corneal decompensation in vitrectomized eyes or aphakic eyes in which DMEK or combined DMEK/scleral-fixated intraocular lens implantation was indicated and in which a specific technique [Cornea-Press (C-Press)] was used to unfold the graft. C-Press is characterized by corneal indentation intended to artificially shallow the anterior chamber and allow the graft to unroll. Best spectacle-corrected visual acuity, central corneal thickness, the time of graft unfolding, endothelial cell count, and the incidence of intraoperative/postoperative complications were analyzed. Eleven eyes of 11 patients (8 men, mean age: 73 ± 12 years) were included. Corrected distance visual acuity (logarithm of the minimum angle of resolution) improved from 1.44 ± 0.23 preoperatively to 0.77 ± 0.36 6 months postoperatively (P < 0.001). Central corneal thickness (CCT) decreased from 644 ± 79 preoperatively to 516 ± 49 μm 6 months postoperatively. The graft unfolding time was 4.4 ± 2.5 minutes. Mean endothelial cell density was 2762 ± 192 preoperatively and 1872 ± 324 cells/mm 6 months postoperatively. No eye showed intraoperative complications. Rebubbling for partial detachment was needed in 2 cases (18%). The C-Press technique enables likely safe and reproducible DMEK surgery in vitrectomized eyes. Further clinical studies with a large number of patients and longer follow-up are required to confirm our preliminary results.

Comparative analysis of biomechanical parameters of the corneas following Descemet membrane endothelial keratoplasty and contralateral healthy corneas.

To compare the biomechanical properties of the unilateral operated corneas in patients who had undergone Descemet membrane endothelial keratoplasty (DMEK) for pseudophakic bullous keratopathy (PBK) with those of the contralateral normal corneas. This was a retrospective cohort study conducted at university hospitals (Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel, and S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia). Forty eyes of 20 patients who underwent DMEK for unilateral PBK 3.5 to 36months ago and with normal fellow eyes were included in the study. An ocular response analyzer was used to measure the corneal biomechanical properties in the operated and normal fellow eyes. The main outcome measures were corneal hysteresis (CH) and corneal resistance factor (CRF). The mean CH (8.4 ± 1.5mmHg vs. 8.2 ± 1.5mmHg, P = 0.707) and the mean CRF (8.7 ± 1.6mmHg vs. 8.3 ± 1.6mmHg, P = 0.419) values did not show any statistically significant difference between the operated and the normal fellow eyes. In our study, the corneas that underwent DMEK for PBK showed normal values for biomechanical parameters. These findings support the previous studies that have reported near complete visual, functional, and ultra-structural rehabilitation of the corneas following DMEK.