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Claus Cursiefen - One of the best experts on this subject based on the ideXlab platform.
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split Cornea Transplantation relationship between storage time of split donor tissue and outcome
Ophthalmology, 2013Co-Authors: Ludwig M Heindl, Stephan Riss, Werner Adler, Franziska Bucher, Deniz Hos, Claus CursiefenAbstract:Purpose To analyze the relationship between storage time of split donor tissue and outcomes after deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK). Design Retrospective analysis of a nonrandomized, consecutive, interventional case series. Participants One hundred ten eyes with anterior stromal disease suitable for DALK and 110 eyes with endothelial disease suitable for DMEK underwent surgically successful split Cornea Transplantation combining both procedures within 7 days after splitting. Methods Split donor storage times (splitting to grafting) and total storage times (death to grafting) were correlated with the 1-year functional and morphologic outcomes after DALK and DMEK surgery using a Spearman correlation coefficient and a Mann–Whitney U test. Main Outcome Measures Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates within 12 months of follow-up. Results The mean split donor storage time was 35±47 hours (range, 0–162 hours) after splitting for anterior donor grafts and 21±40 hours (range, 0–158 hours) for posterior grafts. The mean total storage time was 352±108 hours (range, 108–678 hours) for anterior lamellas and 339±109 hours (range, 96–630 hours) for posterior lamellas. One year after DALK, the mean BSCVA was 20/30 (range, 20/50–20/20), endothelial cell loss was 8% (range, 2%–16%), and the complication rate (Descemet's folds, epitheliopathy, loose sutures) was 18%. One year after DMEK, the mean BSCVA was 20/25 (range, 20/40–20/16), endothelial cell loss was 41% (range, 17%–63%), and the complication rate (partial graft detachment) was 62%. For DALK and DMEK, no significant association was observed between split donor storage time as well as total storage time and BSCVA ( P ≥0.409), endothelial cell loss ( P ≥0.236), or complication rate ( P ≥0.647) within 1 year of follow-up. Conclusions Anterior and posterior donor tissue may be stored safely for up to 1 week in organ culture before use in DALK and DMEK surgery. This simplifies the clinical feasibility of split Cornea Transplantation to reduce donor shortage and cost in Corneal Transplantation in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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split Cornea Transplantation for 2 recipients review of the first 100 consecutive patients
American Journal of Ophthalmology, 2011Co-Authors: Ludwig M Heindl, Stephan Riss, Kathrin Laaser, Bjoern O Bachmann, Friedrich E Kruse, Claus CursiefenAbstract:Purpose To evaluate the feasibility of split Cornea Transplantation for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Design Interventional case series. Methods Fifty consecutive eyes with anterior stromal disease suitable for DALK and 50 eyes with endothelial disease suitable for DMEK were scheduled for split Cornea Transplantation combining both procedures within 72 hours. Main outcome measures included success of using a single donor Cornea for 2 recipients, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months' follow-up. Results A single donor Cornea could be used for 2 recipients in 47 cases (94%). In 3 eyes (6%), the DALK procedure had to be converted to penetrating keratoplasty (PK) requiring a full-thickness Corneal graft. Thereby, 47 donor Corneas (47%) could be saved. Six months after surgery, mean BSCVA was 20/36 in the 47 eyes that underwent successful DALK, 20/50 in the 3 eyes that underwent conversion from DALK to PK, and 20/29 in the 50 eyes that underwent DMEK. Postoperative complications after DALK included Descemet folds in 5 eyes (11%) and epitheliopathy in 3 eyes (6%). After DMEK, partial graft detachment occurred in 26 eyes (52%) and was managed successfully with intracameral air reinjection. All Corneas remained clear up to 6 months after surgery. No intraocular infections occurred. Conclusion Split use of donor Corneal tissue for combined DALK and DMEK procedures in 2 recipients within 3 subsequent days is a feasible approach to reduce donor shortage in Corneal Transplantation in the future.
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split Cornea Transplantation for 2 recipients a new strategy to reduce Corneal tissue cost and shortage
Ophthalmology, 2011Co-Authors: Ludwig M Heindl, Stephan Riss, Kathrin Laaser, Bjoern O Bachmann, Friedrich E Kruse, Claus CursiefenAbstract:Purpose To evaluate the feasibility of using a single donor Cornea for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) surgeries on the same day. Design Single-center, nonrandomized, prospective, interventional case series. Participants Twelve consecutive donor Corneas were scheduled for split Cornea Transplantation combining DALK for a keratoconus patient and DMEK for a Fuchs' endothelial dystrophy patient on the same surgery day. Methods First, a big-bubble DALK procedure was performed for the keratoconus eye. When bare Descemet's membrane was prepared successfully requiring no conversion to penetrating keratoplasty (PK), then during surgery the donor, endothelium–Descemet's membrane layer was removed and stored for subsequent DMEK in a second patient, and the remaining anterior lamella of the donor Cornea was used to complete the DALK surgery. Afterward, a DMEK procedure was performed on the second patient with Fuchs' endothelial dystrophy, grafting the stored endothelium–Descemet's membrane layer of the original donor button. Main Outcome Measures Success of using a single donor Cornea for 2 recipient eyes, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months follow-up. Results A single donor Cornea could be used for 2 recipients in 10 of 12 donor buttons (83%). In 2 cases (17%), the DALK procedure had to be converted to PK requiring a full-thickness Corneal graft. Therefore, 10 donor Corneas (45%) could be saved. Six months after surgery, mean BSCVA was 20/35 (range, 20/50–20/25) in 10 eyes that underwent successful DALK, 20/50 (range, 20/63–20/40) in 2 eyes that underwent conversion from DALK to PK, and 20/31 (range, 20/50–20/16) in 10 eyes that underwent DMEK. Postoperative complications after DALK included Descemet's folds in 3 eyes (30%) and epitheliopathy in 2 eyes (20%). After DMEK, partial graft detachment occurred in 5 eyes (50%) and was managed successfully with intracameral air reinjection. All Corneas remained clear up to 6 months after surgery. Conclusions Split use of donor Corneal tissue for combined DALK and DMEK procedures in 2 recipients on the same surgery day is a promising strategy to reduce donor shortage and cost in Corneal Transplantation surgery in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Yaron S Rabinowitz - One of the best experts on this subject based on the ideXlab platform.
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variation in the lysyl oxidase lox gene is associated with keratoconus in family based and case control studies
Investigative Ophthalmology & Visual Science, 2012Co-Authors: Yelena Bykhovskaya, Irina Epifantseva, Talin Haritunians, David S Siscovick, Anthony J Aldave, Loretta B Szczotkaflynn, Sudha K Iyengar, Kent D Taylor, Jerome I Rotter, Yaron S RabinowitzAbstract:Purpose. Keratoconus is a bilateral noninflammatory progressive Corneal disorder with complex genetic inheritance and a common cause for Cornea Transplantation in young adults. A genomewide linkage scan in keratoconus families identified a locus at 5q23.2, overlapping the gene coding for the lysyl oxidase (LOX). LOX encodes an enzyme responsible for collagen cross-linking in a variety of tissues including the Cornea. Corneal collagen cross-linking with long-wave ultraviolet light and riboflavin is a promising new treatment for keratoconus. To determine whether LOX is a genetic determinant of the pathogenesis of keratoconus, we analyzed association results of LOX polymorphisms in two independent case-control samples and in keratoconus families.
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variation in the lysyl oxidase lox gene is associated with keratoconus in family based and case control studies
Investigative Ophthalmology & Visual Science, 2012Co-Authors: Yelena Bykhovskaya, Irina Epifantseva, Talin Haritunians, David S Siscovick, Anthony J Aldave, Loretta B Szczotkaflynn, Sudha K Iyengar, Kent D Taylor, Jerome I Rotter, Yaron S RabinowitzAbstract:PURPOSE. Keratoconus is a bilateral noninflammatory progressive Corneal disorder with complex genetic inheritance and a common cause for Cornea Transplantation in young adults. A genomewide linkage scan in keratoconus families identified a locus at 5q23.2, overlapping the gene coding for the lysyl oxidase (LOX). LOX encodes an enzyme responsible for collagen cross-linking in a variety of tissues including the Cornea. Corneal collagen cross-linking with long-wave ultraviolet light and riboflavin is a promising new treatment for keratoconus. To determine whether LOX is a genetic determinant of the pathogenesis of keratoconus, we analyzed association results of LOX polymorphisms in two independent case-control samples and in keratoconus families. METHODS. Association results were analyzed of single-nucleotide polymorphisms (SNPs) in the LOX gene from a GenomeWide Association Study (GWAS) investigation in two independent panels of patients with keratoconus and controls and in keratoconus families. RESULTS. Evidence of association was found at SNPs rs10519694 and rs2956540 located in intron 4 of LOX in the GWAS discovery case-control panel with P values of 2.3 3 10 � 3 and 7 3 10 � 3 , respectively. The same two SNPs were found to be associated with keratoconus by family-based association testing with P values of 2.7 3 10 � 3 and 7.7 3 10 � 4 , respectively. Meta P values of 4.0 3 10 � 5 and 4.0 3 10 � 7 were calculated for SNPs rs10519694 and rs2956540 by analyzing case-control and family samples simultaneously. Sequencing of LOX exons in a subset of keratoconus patients identified two polymorphisms, rs1800449 and rs2288393, located in LOX transcripts I and II, associated with keratoconus in case-control and family samples with a meta P value of 0.02.
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a genome wide association study identifies a potential novel gene locus for keratoconus one of the commonest causes for Corneal Transplantation in developed countries
Human Molecular Genetics, 2012Co-Authors: Yelena Bykhovskaya, Talin Haritunians, David S Siscovick, Anthony J Aldave, Loretta B Szczotkaflynn, Sudha K Iyengar, Kent D Taylor, Jerome I Rotter, Yaron S RabinowitzAbstract:Keratoconus is a condition in which the Cornea progressively thins over time, and is a major cause for Cornea Transplantation. To identify keratoconus susceptibility regions, we performed a comprehensive genome-wide association study (GWAS) using a discovery and replication design. A discovery panel of 222 keratoconus Caucasian patients and 3324 Caucasian controls was genotyped using Illumina 370K beadchips. Further associated and fine-mapping single nucleotide polymorphisms (SNPs) (n= 4905) were genotyped in an independent replication case-control panel of 304 cases and 518 controls and a family panel of 307 subjects in 70 families. Logistic regression models implemented in PLINK were performed to test associations in case-control samples with and without principal component (PC) adjustments. Generalized estimation equation models accounting for familial correlations implemented in GWAF were used for association testing in families. No genome-wide associations were identified in the discovery GWAS panel. From the initial testing without adjustments for PCs, the top three SNPs located at 3p26 (rs6442925), 2q21.3 (rs4954218) and 19q13.3 (rs1428642) were identified with unadjusted P-values of 6.5 × 10(-8), 2.4 × 10(-7) and 3.1 × 10(-7), respectively. After adjustments for PCs, rs1428642 became the most significant through the genome with a P-value of 1.4 × 10(-6), while rs6442925 and rs4954218 were less significant (P= 1.9 × 10(-5) and 2.6 × 10(-4)). SNP rs4954218 was confirmed in two independent replication panels with P-values of 0.004 and 0.009, respectively. Meta-analysis revealed a highest association at rs4954218 with adjusted P= 1.6 × 10(-7) (unadjusted P= 1.2 × 10(-9)). These findings suggest SNP rs4954218, located near the RAB3GAP1 gene, previously reported to be associated with Corneal malformation, is a potential susceptibility locus for keratoconus.
Ludwig M Heindl - One of the best experts on this subject based on the ideXlab platform.
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split Cornea Transplantation relationship between storage time of split donor tissue and outcome
Ophthalmology, 2013Co-Authors: Ludwig M Heindl, Stephan Riss, Werner Adler, Franziska Bucher, Deniz Hos, Claus CursiefenAbstract:Purpose To analyze the relationship between storage time of split donor tissue and outcomes after deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK). Design Retrospective analysis of a nonrandomized, consecutive, interventional case series. Participants One hundred ten eyes with anterior stromal disease suitable for DALK and 110 eyes with endothelial disease suitable for DMEK underwent surgically successful split Cornea Transplantation combining both procedures within 7 days after splitting. Methods Split donor storage times (splitting to grafting) and total storage times (death to grafting) were correlated with the 1-year functional and morphologic outcomes after DALK and DMEK surgery using a Spearman correlation coefficient and a Mann–Whitney U test. Main Outcome Measures Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates within 12 months of follow-up. Results The mean split donor storage time was 35±47 hours (range, 0–162 hours) after splitting for anterior donor grafts and 21±40 hours (range, 0–158 hours) for posterior grafts. The mean total storage time was 352±108 hours (range, 108–678 hours) for anterior lamellas and 339±109 hours (range, 96–630 hours) for posterior lamellas. One year after DALK, the mean BSCVA was 20/30 (range, 20/50–20/20), endothelial cell loss was 8% (range, 2%–16%), and the complication rate (Descemet's folds, epitheliopathy, loose sutures) was 18%. One year after DMEK, the mean BSCVA was 20/25 (range, 20/40–20/16), endothelial cell loss was 41% (range, 17%–63%), and the complication rate (partial graft detachment) was 62%. For DALK and DMEK, no significant association was observed between split donor storage time as well as total storage time and BSCVA ( P ≥0.409), endothelial cell loss ( P ≥0.236), or complication rate ( P ≥0.647) within 1 year of follow-up. Conclusions Anterior and posterior donor tissue may be stored safely for up to 1 week in organ culture before use in DALK and DMEK surgery. This simplifies the clinical feasibility of split Cornea Transplantation to reduce donor shortage and cost in Corneal Transplantation in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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split Cornea Transplantation for 2 recipients review of the first 100 consecutive patients
American Journal of Ophthalmology, 2011Co-Authors: Ludwig M Heindl, Stephan Riss, Kathrin Laaser, Bjoern O Bachmann, Friedrich E Kruse, Claus CursiefenAbstract:Purpose To evaluate the feasibility of split Cornea Transplantation for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Design Interventional case series. Methods Fifty consecutive eyes with anterior stromal disease suitable for DALK and 50 eyes with endothelial disease suitable for DMEK were scheduled for split Cornea Transplantation combining both procedures within 72 hours. Main outcome measures included success of using a single donor Cornea for 2 recipients, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months' follow-up. Results A single donor Cornea could be used for 2 recipients in 47 cases (94%). In 3 eyes (6%), the DALK procedure had to be converted to penetrating keratoplasty (PK) requiring a full-thickness Corneal graft. Thereby, 47 donor Corneas (47%) could be saved. Six months after surgery, mean BSCVA was 20/36 in the 47 eyes that underwent successful DALK, 20/50 in the 3 eyes that underwent conversion from DALK to PK, and 20/29 in the 50 eyes that underwent DMEK. Postoperative complications after DALK included Descemet folds in 5 eyes (11%) and epitheliopathy in 3 eyes (6%). After DMEK, partial graft detachment occurred in 26 eyes (52%) and was managed successfully with intracameral air reinjection. All Corneas remained clear up to 6 months after surgery. No intraocular infections occurred. Conclusion Split use of donor Corneal tissue for combined DALK and DMEK procedures in 2 recipients within 3 subsequent days is a feasible approach to reduce donor shortage in Corneal Transplantation in the future.
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split Cornea Transplantation for 2 recipients a new strategy to reduce Corneal tissue cost and shortage
Ophthalmology, 2011Co-Authors: Ludwig M Heindl, Stephan Riss, Kathrin Laaser, Bjoern O Bachmann, Friedrich E Kruse, Claus CursiefenAbstract:Purpose To evaluate the feasibility of using a single donor Cornea for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) surgeries on the same day. Design Single-center, nonrandomized, prospective, interventional case series. Participants Twelve consecutive donor Corneas were scheduled for split Cornea Transplantation combining DALK for a keratoconus patient and DMEK for a Fuchs' endothelial dystrophy patient on the same surgery day. Methods First, a big-bubble DALK procedure was performed for the keratoconus eye. When bare Descemet's membrane was prepared successfully requiring no conversion to penetrating keratoplasty (PK), then during surgery the donor, endothelium–Descemet's membrane layer was removed and stored for subsequent DMEK in a second patient, and the remaining anterior lamella of the donor Cornea was used to complete the DALK surgery. Afterward, a DMEK procedure was performed on the second patient with Fuchs' endothelial dystrophy, grafting the stored endothelium–Descemet's membrane layer of the original donor button. Main Outcome Measures Success of using a single donor Cornea for 2 recipient eyes, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months follow-up. Results A single donor Cornea could be used for 2 recipients in 10 of 12 donor buttons (83%). In 2 cases (17%), the DALK procedure had to be converted to PK requiring a full-thickness Corneal graft. Therefore, 10 donor Corneas (45%) could be saved. Six months after surgery, mean BSCVA was 20/35 (range, 20/50–20/25) in 10 eyes that underwent successful DALK, 20/50 (range, 20/63–20/40) in 2 eyes that underwent conversion from DALK to PK, and 20/31 (range, 20/50–20/16) in 10 eyes that underwent DMEK. Postoperative complications after DALK included Descemet's folds in 3 eyes (30%) and epitheliopathy in 2 eyes (20%). After DMEK, partial graft detachment occurred in 5 eyes (50%) and was managed successfully with intracameral air reinjection. All Corneas remained clear up to 6 months after surgery. Conclusions Split use of donor Corneal tissue for combined DALK and DMEK procedures in 2 recipients on the same surgery day is a promising strategy to reduce donor shortage and cost in Corneal Transplantation surgery in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Yelena Bykhovskaya - One of the best experts on this subject based on the ideXlab platform.
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variation in the lysyl oxidase lox gene is associated with keratoconus in family based and case control studies
Investigative Ophthalmology & Visual Science, 2012Co-Authors: Yelena Bykhovskaya, Irina Epifantseva, Talin Haritunians, David S Siscovick, Anthony J Aldave, Loretta B Szczotkaflynn, Sudha K Iyengar, Kent D Taylor, Jerome I Rotter, Yaron S RabinowitzAbstract:Purpose. Keratoconus is a bilateral noninflammatory progressive Corneal disorder with complex genetic inheritance and a common cause for Cornea Transplantation in young adults. A genomewide linkage scan in keratoconus families identified a locus at 5q23.2, overlapping the gene coding for the lysyl oxidase (LOX). LOX encodes an enzyme responsible for collagen cross-linking in a variety of tissues including the Cornea. Corneal collagen cross-linking with long-wave ultraviolet light and riboflavin is a promising new treatment for keratoconus. To determine whether LOX is a genetic determinant of the pathogenesis of keratoconus, we analyzed association results of LOX polymorphisms in two independent case-control samples and in keratoconus families.
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variation in the lysyl oxidase lox gene is associated with keratoconus in family based and case control studies
Investigative Ophthalmology & Visual Science, 2012Co-Authors: Yelena Bykhovskaya, Irina Epifantseva, Talin Haritunians, David S Siscovick, Anthony J Aldave, Loretta B Szczotkaflynn, Sudha K Iyengar, Kent D Taylor, Jerome I Rotter, Yaron S RabinowitzAbstract:PURPOSE. Keratoconus is a bilateral noninflammatory progressive Corneal disorder with complex genetic inheritance and a common cause for Cornea Transplantation in young adults. A genomewide linkage scan in keratoconus families identified a locus at 5q23.2, overlapping the gene coding for the lysyl oxidase (LOX). LOX encodes an enzyme responsible for collagen cross-linking in a variety of tissues including the Cornea. Corneal collagen cross-linking with long-wave ultraviolet light and riboflavin is a promising new treatment for keratoconus. To determine whether LOX is a genetic determinant of the pathogenesis of keratoconus, we analyzed association results of LOX polymorphisms in two independent case-control samples and in keratoconus families. METHODS. Association results were analyzed of single-nucleotide polymorphisms (SNPs) in the LOX gene from a GenomeWide Association Study (GWAS) investigation in two independent panels of patients with keratoconus and controls and in keratoconus families. RESULTS. Evidence of association was found at SNPs rs10519694 and rs2956540 located in intron 4 of LOX in the GWAS discovery case-control panel with P values of 2.3 3 10 � 3 and 7 3 10 � 3 , respectively. The same two SNPs were found to be associated with keratoconus by family-based association testing with P values of 2.7 3 10 � 3 and 7.7 3 10 � 4 , respectively. Meta P values of 4.0 3 10 � 5 and 4.0 3 10 � 7 were calculated for SNPs rs10519694 and rs2956540 by analyzing case-control and family samples simultaneously. Sequencing of LOX exons in a subset of keratoconus patients identified two polymorphisms, rs1800449 and rs2288393, located in LOX transcripts I and II, associated with keratoconus in case-control and family samples with a meta P value of 0.02.
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a genome wide association study identifies a potential novel gene locus for keratoconus one of the commonest causes for Corneal Transplantation in developed countries
Human Molecular Genetics, 2012Co-Authors: Yelena Bykhovskaya, Talin Haritunians, David S Siscovick, Anthony J Aldave, Loretta B Szczotkaflynn, Sudha K Iyengar, Kent D Taylor, Jerome I Rotter, Yaron S RabinowitzAbstract:Keratoconus is a condition in which the Cornea progressively thins over time, and is a major cause for Cornea Transplantation. To identify keratoconus susceptibility regions, we performed a comprehensive genome-wide association study (GWAS) using a discovery and replication design. A discovery panel of 222 keratoconus Caucasian patients and 3324 Caucasian controls was genotyped using Illumina 370K beadchips. Further associated and fine-mapping single nucleotide polymorphisms (SNPs) (n= 4905) were genotyped in an independent replication case-control panel of 304 cases and 518 controls and a family panel of 307 subjects in 70 families. Logistic regression models implemented in PLINK were performed to test associations in case-control samples with and without principal component (PC) adjustments. Generalized estimation equation models accounting for familial correlations implemented in GWAF were used for association testing in families. No genome-wide associations were identified in the discovery GWAS panel. From the initial testing without adjustments for PCs, the top three SNPs located at 3p26 (rs6442925), 2q21.3 (rs4954218) and 19q13.3 (rs1428642) were identified with unadjusted P-values of 6.5 × 10(-8), 2.4 × 10(-7) and 3.1 × 10(-7), respectively. After adjustments for PCs, rs1428642 became the most significant through the genome with a P-value of 1.4 × 10(-6), while rs6442925 and rs4954218 were less significant (P= 1.9 × 10(-5) and 2.6 × 10(-4)). SNP rs4954218 was confirmed in two independent replication panels with P-values of 0.004 and 0.009, respectively. Meta-analysis revealed a highest association at rs4954218 with adjusted P= 1.6 × 10(-7) (unadjusted P= 1.2 × 10(-9)). These findings suggest SNP rs4954218, located near the RAB3GAP1 gene, previously reported to be associated with Corneal malformation, is a potential susceptibility locus for keratoconus.
Stephan Riss - One of the best experts on this subject based on the ideXlab platform.
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split Cornea Transplantation relationship between storage time of split donor tissue and outcome
Ophthalmology, 2013Co-Authors: Ludwig M Heindl, Stephan Riss, Werner Adler, Franziska Bucher, Deniz Hos, Claus CursiefenAbstract:Purpose To analyze the relationship between storage time of split donor tissue and outcomes after deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK). Design Retrospective analysis of a nonrandomized, consecutive, interventional case series. Participants One hundred ten eyes with anterior stromal disease suitable for DALK and 110 eyes with endothelial disease suitable for DMEK underwent surgically successful split Cornea Transplantation combining both procedures within 7 days after splitting. Methods Split donor storage times (splitting to grafting) and total storage times (death to grafting) were correlated with the 1-year functional and morphologic outcomes after DALK and DMEK surgery using a Spearman correlation coefficient and a Mann–Whitney U test. Main Outcome Measures Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates within 12 months of follow-up. Results The mean split donor storage time was 35±47 hours (range, 0–162 hours) after splitting for anterior donor grafts and 21±40 hours (range, 0–158 hours) for posterior grafts. The mean total storage time was 352±108 hours (range, 108–678 hours) for anterior lamellas and 339±109 hours (range, 96–630 hours) for posterior lamellas. One year after DALK, the mean BSCVA was 20/30 (range, 20/50–20/20), endothelial cell loss was 8% (range, 2%–16%), and the complication rate (Descemet's folds, epitheliopathy, loose sutures) was 18%. One year after DMEK, the mean BSCVA was 20/25 (range, 20/40–20/16), endothelial cell loss was 41% (range, 17%–63%), and the complication rate (partial graft detachment) was 62%. For DALK and DMEK, no significant association was observed between split donor storage time as well as total storage time and BSCVA ( P ≥0.409), endothelial cell loss ( P ≥0.236), or complication rate ( P ≥0.647) within 1 year of follow-up. Conclusions Anterior and posterior donor tissue may be stored safely for up to 1 week in organ culture before use in DALK and DMEK surgery. This simplifies the clinical feasibility of split Cornea Transplantation to reduce donor shortage and cost in Corneal Transplantation in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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split Cornea Transplantation for 2 recipients review of the first 100 consecutive patients
American Journal of Ophthalmology, 2011Co-Authors: Ludwig M Heindl, Stephan Riss, Kathrin Laaser, Bjoern O Bachmann, Friedrich E Kruse, Claus CursiefenAbstract:Purpose To evaluate the feasibility of split Cornea Transplantation for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Design Interventional case series. Methods Fifty consecutive eyes with anterior stromal disease suitable for DALK and 50 eyes with endothelial disease suitable for DMEK were scheduled for split Cornea Transplantation combining both procedures within 72 hours. Main outcome measures included success of using a single donor Cornea for 2 recipients, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months' follow-up. Results A single donor Cornea could be used for 2 recipients in 47 cases (94%). In 3 eyes (6%), the DALK procedure had to be converted to penetrating keratoplasty (PK) requiring a full-thickness Corneal graft. Thereby, 47 donor Corneas (47%) could be saved. Six months after surgery, mean BSCVA was 20/36 in the 47 eyes that underwent successful DALK, 20/50 in the 3 eyes that underwent conversion from DALK to PK, and 20/29 in the 50 eyes that underwent DMEK. Postoperative complications after DALK included Descemet folds in 5 eyes (11%) and epitheliopathy in 3 eyes (6%). After DMEK, partial graft detachment occurred in 26 eyes (52%) and was managed successfully with intracameral air reinjection. All Corneas remained clear up to 6 months after surgery. No intraocular infections occurred. Conclusion Split use of donor Corneal tissue for combined DALK and DMEK procedures in 2 recipients within 3 subsequent days is a feasible approach to reduce donor shortage in Corneal Transplantation in the future.
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split Cornea Transplantation for 2 recipients a new strategy to reduce Corneal tissue cost and shortage
Ophthalmology, 2011Co-Authors: Ludwig M Heindl, Stephan Riss, Kathrin Laaser, Bjoern O Bachmann, Friedrich E Kruse, Claus CursiefenAbstract:Purpose To evaluate the feasibility of using a single donor Cornea for 2 recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) surgeries on the same day. Design Single-center, nonrandomized, prospective, interventional case series. Participants Twelve consecutive donor Corneas were scheduled for split Cornea Transplantation combining DALK for a keratoconus patient and DMEK for a Fuchs' endothelial dystrophy patient on the same surgery day. Methods First, a big-bubble DALK procedure was performed for the keratoconus eye. When bare Descemet's membrane was prepared successfully requiring no conversion to penetrating keratoplasty (PK), then during surgery the donor, endothelium–Descemet's membrane layer was removed and stored for subsequent DMEK in a second patient, and the remaining anterior lamella of the donor Cornea was used to complete the DALK surgery. Afterward, a DMEK procedure was performed on the second patient with Fuchs' endothelial dystrophy, grafting the stored endothelium–Descemet's membrane layer of the original donor button. Main Outcome Measures Success of using a single donor Cornea for 2 recipient eyes, best spectacle-corrected visual acuity (BSCVA), and complication rates within 6 months follow-up. Results A single donor Cornea could be used for 2 recipients in 10 of 12 donor buttons (83%). In 2 cases (17%), the DALK procedure had to be converted to PK requiring a full-thickness Corneal graft. Therefore, 10 donor Corneas (45%) could be saved. Six months after surgery, mean BSCVA was 20/35 (range, 20/50–20/25) in 10 eyes that underwent successful DALK, 20/50 (range, 20/63–20/40) in 2 eyes that underwent conversion from DALK to PK, and 20/31 (range, 20/50–20/16) in 10 eyes that underwent DMEK. Postoperative complications after DALK included Descemet's folds in 3 eyes (30%) and epitheliopathy in 2 eyes (20%). After DMEK, partial graft detachment occurred in 5 eyes (50%) and was managed successfully with intracameral air reinjection. All Corneas remained clear up to 6 months after surgery. Conclusions Split use of donor Corneal tissue for combined DALK and DMEK procedures in 2 recipients on the same surgery day is a promising strategy to reduce donor shortage and cost in Corneal Transplantation surgery in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.