Descemet Membrane

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Gerrit R J Melles - One of the best experts on this subject based on the ideXlab platform.

Marianne O Price - One of the best experts on this subject based on the ideXlab platform.

Francis W Price - One of the best experts on this subject based on the ideXlab platform.

Lisanne Ham - One of the best experts on this subject based on the ideXlab platform.

  • prevention and management of Descemet Membrane endothelial keratoplasty complications
    Cornea, 2017
    Co-Authors: Ruth Quilendrino, Isabel Dapena, Lamis Baydoun, Korine Van Dijk, Lisanne Ham, Marina Rodriguezcalvo De Mora, Silke Oellerich, Gerrit R J Melles
    Abstract:

    Purpose:To describe Descemet Membrane endothelial keratoplasty (DMEK) complications and strategies for their prevention and management.Methods:Five hundred consecutive eyes with DMEK of 393 patients were reviewed in this retrospective study for intraoperative and postoperative complications up to 2

  • rebubbling techniques for graft detachment after Descemet Membrane endothelial keratoplasty
    Cornea, 2016
    Co-Authors: Ester Fernandez Lopez, Isabel Dapena, Lamis Baydoun, Lisanne Ham, Vasilios S. Liarakos, Nadine Gerberhollbach, Gerrit R J Melles
    Abstract:

    Purpose:To describe rebubbling techniques in eyes with a visually significant graft detachment after Descemet Membrane endothelial keratoplasty (DMEK).Methods:Retrospective observational analysis at a tertiary referral center. A total of 41 eyes (39 patients) received rebubbling: 39 eyes (37 patient

  • repeat Descemet Membrane endothelial keratoplasty after complicated primary Descemet Membrane endothelial keratoplasty
    Ophthalmology, 2015
    Co-Authors: Lamis Baydoun, Isabel Dapena, Korine Van Dijk, Lisanne Ham, Vasilios S. Liarakos, Fayyaz U Musa, Gerrit R J Melles
    Abstract:

    Purpose To describe the clinical outcome and complications of repeat Descemet Membrane endothelial keratoplasty (re-DMEK). Design Retrospective case series study at a tertiary referral center. Participants From a series of 550 consecutive DMEK surgeries with ≥6 months follow-up, 17 eyes underwent re-DMEK for graft detachment after initial DMEK (n = 14) and/or endothelial graft failure (n = 3). The outcomes were compared with an age-matched control group of uncomplicated primary DMEK surgeries. Methods The re-DMEK eyes were evaluated for best-corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications. Main Outcome Measures Feasibility and clinical outcome of re-DMEK. Results In all eyes, re-DMEK was uneventful. At 12 months, 12 of 14 eyes (86%) achieved a BCVA of ≥20/40 (≥0.5); 8 of 14 eyes (57%) achieved ≥20/25 (≥0.8), 3 of 14 eyes (21%) achieved ≥20/20 (≥1.0), and 1 eye (7%) achieved 20/17 (1.2); 5 eyes were fitted with a contact lens. Average donor ECD decreased from 2580±173 cells/mm 2 before to 1390±466 cells/mm 2 at 6 months after surgery, and pachymetry from 703±126 μm to 515±39 μm, respectively. No difference in densitometry could be detected between re-DMEK and control eyes ( P  = 0.99). Complications after re-DMEK included primary graft failure (n = 1), secondary graft failure (n = 2), graft detachment requiring rebubbling (n = 1), secondary glaucoma (n = 2), cataract (n = 1), and corneal ulcer (n = 1). One eye received tertiary DMEK. Conclusions In the management of persistent graft detachment and graft failure after primary DMEK, re-DMEK proved a feasible procedure. Acceptable BCVA may be achieved, albeit lower than after DMEK in virgin eyes, and some cases may benefit from contact lens fitting. Complications after re-DMEK may be better anticipated than after primary DMEK because graft detachment and graft failure tended to recur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure.

  • Intraocular graft unfolding techniques in Descemet Membrane endothelial keratoplasty.
    JAMA ophthalmology, 2013
    Co-Authors: Vasilios S. Liarakos, Isabel Dapena, Korine Van Dijk, Lisanne Ham, Gerrit R J Melles
    Abstract:

    Objective To define various Descemet graft unfolding techniques in Descemet Membrane endothelial keratoplasty. Methods In a retrospective analysis, the surgical videos of 100 consecutive Descemet Membrane endothelial keratoplasty cases with at least 6 months of follow-up were evaluated and categorized. The Descemet graft unfolding methods were categorized into 4 basic techniques and 3 auxiliary techniques. Results All Descemet Membrane endothelial keratoplasty surgical procedures could be completed using (a combination of) 4 Descemet graft unfolding techniques: (1) standardized no-touch graft unfolding using a double roll, (2) carpet unrolling while fixating 1 graft edge (Dirisamer technique), (3) small air bubble–assisted unrolling (Dapena maneuver), (4) the single sliding cannula maneuver. Additional maneuvers included turning over the graft when oriented upside down (flushing); manual graft centration with a cannula; and bubble bumping to unfold peripheral inward folds. In 73% of surgical procedures, technique 1 was used, while a combination of techniques was used in 44% and auxiliary techniques in 62%. None of the techniques showed a correlation with the best-corrected visual acuity, endothelial cell density, or postoperative complication rate (P > .10). Conclusions Descemet Membrane endothelial keratoplasty may be further facilitated by using controlled techniques for unfolding the Descemet graft inside the recipient anterior chamber, either as stand-alone techniques or used in various combinations.

  • recipient endothelium may relate to corneal clearance in Descemet Membrane endothelial transfer
    American Journal of Ophthalmology, 2012
    Co-Authors: Martin Dirisamer, Isabel Dapena, Korine Van Dijk, Lisanne Ham, Ruyin Yeh, Gerrit R J Melles
    Abstract:

    Purpose To describe corneal clearance after re-endothelialization of the recipient posterior stroma through Descemet Membrane endothelial transfer (DMET) (ie, a "free-floating" donor Descemet graft in the recipient anterior chamber after Descemetorhexis), in managing corneal endothelial disorders. Design Nonrandomized prospective study at a tertiary referral center. Methods Twelve eyes enrolled in our study, 7 suffering from Fuchs endothelial dystrophy and 5 with bullous keratopathy. The clinical outcome was monitored by biomicroscopy, optical coherence tomography, confocal microscopy, endothelial cell density, and pachymetry measurements. Results All eyes operated on for Fuchs endothelial dystrophy showed corneal clearance, with pachymetry values returning to normal (533 ±47 μm). The denuded recipient stroma re-endothelialized with an average endothelial cell density of 797 (± 743) cells/mm 2 at 6 months after surgery. In contrast, none of the bullous keratopathy eyes showed any improvement throughout the follow-up period. Conclusion DMET may be effective in the management of Fuchs endothelial dystrophy (primarily a Descemet Membrane disorder), but not in bullous keratopathy (primarily an endothelial depletion). Apparently, the indication for surgery (ie, a "dystrophy" vs a "depletion" of recipient endothelial cells) relates to the capacity of the cornea to clear. This suggests that the remaining rim of recipient endothelium (after Descemetorhexis) is involved in the re-endothelialization of the recipient posterior stroma after DMET.

Isabel Dapena - One of the best experts on this subject based on the ideXlab platform.

  • are Descemet Membrane ruptures the root cause of corneal hydrops in keratoconic eyes
    American Journal of Ophthalmology, 2019
    Co-Authors: Jack S Parker, Isabel Dapena, Korine Van Dijk, Renuka S Birbal, Silke Oellerich, Gerrit R J Melles
    Abstract:

    Purpose To challenge the current consensus on the mechanism causing corneal hydrops in eyes with keratoconus (KC). Design Retrospective, interventional case series. Methods Sixteen eyes of 10 patients with comorbid KC and Fuchs endothelial corneal dystrophy (FECD) underwent uncomplicated Descemet Membrane endothelial keratoplasty (DMEK), and 5 eyes of 5 patients with KC alone underwent Bowman layer (BL) transplantation complicated by inadvertent perforation of the posterior corneal stroma and Descemet Membrane (DM). The presence or absence of hydrops was assessed by intra- and postoperative optical coherence tomography and by slit-lamp biomicroscopy. Results None of the 16 DMEK eyes manifested a hydrops at any time during or after surgery. By contrast, all 5 eyes undergoing BL transplantation complicated by posterior corneal perforation demonstrated a corneal hydrops, evident both intra- and postoperatively. Conclusions In eyes with KC, even the complete removal of DM did not produce a hydrops, whereas a combined defect in DM and the posterior corneal stroma seemed to consistently elicit a typical corneal hydrops.

  • prevention and management of Descemet Membrane endothelial keratoplasty complications
    Cornea, 2017
    Co-Authors: Ruth Quilendrino, Isabel Dapena, Lamis Baydoun, Korine Van Dijk, Lisanne Ham, Marina Rodriguezcalvo De Mora, Silke Oellerich, Gerrit R J Melles
    Abstract:

    Purpose:To describe Descemet Membrane endothelial keratoplasty (DMEK) complications and strategies for their prevention and management.Methods:Five hundred consecutive eyes with DMEK of 393 patients were reviewed in this retrospective study for intraoperative and postoperative complications up to 2

  • case report of quarter Descemet Membrane endothelial keratoplasty for fuchs endothelial dystrophy
    Cornea, 2017
    Co-Authors: Thomas M Muller, Isabel Dapena, Itay Lavy, Lamis Baydoun, Gerrit R J Melles
    Abstract:

    Purpose:To describe a further modification of Descemet Membrane endothelial keratoplasty (DMEK), using a quarter of an untrephined full-size donor Descemet Membrane (DM) sheet (“Quarter-DMEK”).Methods:A 58-year-old patient underwent Quarter-DMEK for Fuchs endothelial dystrophy in his pseudophakic ri

  • rebubbling techniques for graft detachment after Descemet Membrane endothelial keratoplasty
    Cornea, 2016
    Co-Authors: Ester Fernandez Lopez, Isabel Dapena, Lamis Baydoun, Lisanne Ham, Vasilios S. Liarakos, Nadine Gerberhollbach, Gerrit R J Melles
    Abstract:

    Purpose:To describe rebubbling techniques in eyes with a visually significant graft detachment after Descemet Membrane endothelial keratoplasty (DMEK).Methods:Retrospective observational analysis at a tertiary referral center. A total of 41 eyes (39 patients) received rebubbling: 39 eyes (37 patient

  • repeat Descemet Membrane endothelial keratoplasty after complicated primary Descemet Membrane endothelial keratoplasty
    Ophthalmology, 2015
    Co-Authors: Lamis Baydoun, Isabel Dapena, Korine Van Dijk, Lisanne Ham, Vasilios S. Liarakos, Fayyaz U Musa, Gerrit R J Melles
    Abstract:

    Purpose To describe the clinical outcome and complications of repeat Descemet Membrane endothelial keratoplasty (re-DMEK). Design Retrospective case series study at a tertiary referral center. Participants From a series of 550 consecutive DMEK surgeries with ≥6 months follow-up, 17 eyes underwent re-DMEK for graft detachment after initial DMEK (n = 14) and/or endothelial graft failure (n = 3). The outcomes were compared with an age-matched control group of uncomplicated primary DMEK surgeries. Methods The re-DMEK eyes were evaluated for best-corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications. Main Outcome Measures Feasibility and clinical outcome of re-DMEK. Results In all eyes, re-DMEK was uneventful. At 12 months, 12 of 14 eyes (86%) achieved a BCVA of ≥20/40 (≥0.5); 8 of 14 eyes (57%) achieved ≥20/25 (≥0.8), 3 of 14 eyes (21%) achieved ≥20/20 (≥1.0), and 1 eye (7%) achieved 20/17 (1.2); 5 eyes were fitted with a contact lens. Average donor ECD decreased from 2580±173 cells/mm 2 before to 1390±466 cells/mm 2 at 6 months after surgery, and pachymetry from 703±126 μm to 515±39 μm, respectively. No difference in densitometry could be detected between re-DMEK and control eyes ( P  = 0.99). Complications after re-DMEK included primary graft failure (n = 1), secondary graft failure (n = 2), graft detachment requiring rebubbling (n = 1), secondary glaucoma (n = 2), cataract (n = 1), and corneal ulcer (n = 1). One eye received tertiary DMEK. Conclusions In the management of persistent graft detachment and graft failure after primary DMEK, re-DMEK proved a feasible procedure. Acceptable BCVA may be achieved, albeit lower than after DMEK in virgin eyes, and some cases may benefit from contact lens fitting. Complications after re-DMEK may be better anticipated than after primary DMEK because graft detachment and graft failure tended to recur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure.

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