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

  • Endothelial Keratoplasty Update 2020.
    Cornea, 2020
    Co-Authors: Marianne O. Price, Matthew T. Feng, Francis W. Price
    Abstract:

    ABSTRACT Endothelial Keratoplasty has revolutionized the treatment of corneal Endothelial dysfunction and lowered the threshold for treatment by providing rapid visual rehabilitation and setting a high standard for safety and efficacy. Over time, Endothelial Keratoplasty techniques have evolved toward the use of thinner tissue to optimize visual outcomes; refinements have facilitated donor tissue preparation, handling, and attachment; and adaptations have expanded utilization in eyes with challenging ocular anatomy. Despite early concerns about graft longevity, emerging 10-year Endothelial cell loss and graft survival data have been encouraging. A shortage of human donor corneas restricts utilization in many areas of the world and is driving a search for Keratoplasty alternatives. Further work is needed to expand the donor supply, minimize impediments to adoption, optimize graft survival, and improve refractive predictability.

  • Evolution of Endothelial Keratoplasty.
    Cornea, 2013
    Co-Authors: Francis W. Price, Marianne O. Price
    Abstract:

    Endothelial Keratoplasty has evolved into a popular alternative to penetrating Keratoplasty (PK) for the treatment of Endothelial dysfunction. Although the earliest iterations were challenging and were not widely adopted, the iteration known as Descemet stripping Endothelial Keratoplasty (DSEK) has gained widespread acceptance. DSEK combines a simplified technique for stripping dysfunctional endothelium from the host cornea and microkeratome dissection of the donor tissue, a step now commonly completed in advance by eye bank technicians. Studies show that a newer Endothelial Keratoplasty iteration, known as Descemet membrane Endothelial Keratoplasty (DMEK), provides an even faster and better visual recovery than DSEK does. In addition, DMEK significantly reduces the risk of immunologic graft rejection episodes compared with that in DSEK or in PK. Although the DMEK donor tissue, consisting of the bare endothelium and Descemet membrane without any stroma, is more challenging to prepare and position in the recipient eye, recent improvements in instrumentation and surgical techniques are increasing the ease and the reliability of the procedure. DSEK successfully mitigates 2 of the main liabilities of PK: ocular surface complications and structural problems (including induced astigmatism and perpetually weak wounds), whereas DMEK further mitigates the 2 principal remaining liabilities of PK: immunologic graft reactions and secondary glaucoma from prolonged topical corticosteroid use.

  • Descemet's membrane Endothelial Keratoplasty surgery: update on the evidence and hurdles to acceptance.
    Current opinion in ophthalmology, 2013
    Co-Authors: Marianne O. Price, Francis W. Price
    Abstract:

    Purpose of reviewDescemet's stripping Endothelial Keratoplasty (DSEK) is the most popular treatment for Endothelial dysfunction, but Descemet's membrane Endothelial Keratoplasty (DMEK) now provides better vision with lower risk of immunologic rejection. Although DMEK is more challenging, advances in

  • Endothelial Keratoplasty: a revolution in evolution.
    Survey of ophthalmology, 2012
    Co-Authors: Arundhati Anshu, Marianne O. Price, Donald T.h. Tan, Francis W. Price
    Abstract:

    Endothelial Keratoplasty (EK) is continually evolving both in surgical technique and clinical outcomes. Descemet's stripping Endothelial Keratoplasty (DSEK) has replaced penetrating Keratoplasty (PK) as the treatment of choice for corneal Endothelial dysfunction. It is safe and predictable and offers early visual rehabilitation. Newer iterations include Descemet's membrane Endothelial Keratoplasty, Descemet's membrane automated Endothelial Keratoplasty, and other hybrid techniques. Early data on these newer EK techniques suggests that they provide significantly better visual outcomes compared to DSEK. Initial 5-year survival data indicates that EK is at least comparable to PK, and more widespread survival data is anticipated. Further work is needed to simultaneously optimize visual outcomes, refractive predictability, and Endothelial cell survival, as well as surgical techniques of donor preparation and insertion.

  • secondary graft failure and repeat Endothelial Keratoplasty after descemet s stripping automated Endothelial Keratoplasty
    Ophthalmology, 2011
    Co-Authors: Erik Letko, Marianne O. Price, David A Price, Elissandro M S Lindoso, Francis W. Price
    Abstract:

    Objective To identify the causes of secondary graft failure after Descemet's stripping automated Endothelial Keratoplasty (DSAEK) and to evaluate the clinical outcomes of repeat Endothelial Keratoplasty (REK) in this patient population. Design Retrospective case series. Participants Patients of a private practice Price Vision Group in Indianapolis, Indiana. Methods An initial consecutive series of primary DSAEK procedures performed by a single surgeon between October 2004 and December 2008 was reviewed to identify reasons for and outcomes of REK. Main Outcome Measures Visual acuity and causes of secondary graft failure. Results In a consecutive series of 1050 primary DSAEK procedures, REK for secondary graft failure was performed in 37 eyes (3.5%). The most common reason for REK in this group was unsatisfactory visual acuity relative to the anticipated vision potential (n = 28/37; 76%). Unsatisfactory visual acuity was associated with abnormalities of donor tissue within the pupillary area, including wrinkles or folds, irregular graft thickness, and opacity in the interface. In the 28 eyes with unacceptable visual acuity after initial DSAEK, the median best spectacle-corrected visual acuity (BSCVA) before and after REK was 20/60 (range, 20/40–20/400) and 20/30 (range, 20/20–20/100), respectively, and 75% had BSCVA 20/40 or better after REK. The mean corneal thickness in the 28 eyes regrafted for unsatisfactory vision before and after REK was 809 μm (range, 642–979 μm) and 657 μm (range, 549–801 μm), respectively. Secondary graft failure caused by Endothelial decompensation was the reason for repeat Endothelial graft in the remaining 9 eyes (9/37; 24%). Eight eyes had a history of glaucoma, and 6 of them had glaucoma surgery. An episode of immune rejection reaction was documented in 6 of 9 eyes with Endothelial decompensation. Conclusions Our data suggest that the most common reason for REK after DSAEK is unsatisfactory vision. Patient and physician expectations for visual acuity are higher with DSAEK compared with penetrating Keratoplasty. Repeat Endothelial Keratoplasty can provide improved vision in selected patients. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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

  • Endothelial Keratoplasty Update 2020.
    Cornea, 2020
    Co-Authors: Marianne O. Price, Matthew T. Feng, Francis W. Price
    Abstract:

    ABSTRACT Endothelial Keratoplasty has revolutionized the treatment of corneal Endothelial dysfunction and lowered the threshold for treatment by providing rapid visual rehabilitation and setting a high standard for safety and efficacy. Over time, Endothelial Keratoplasty techniques have evolved toward the use of thinner tissue to optimize visual outcomes; refinements have facilitated donor tissue preparation, handling, and attachment; and adaptations have expanded utilization in eyes with challenging ocular anatomy. Despite early concerns about graft longevity, emerging 10-year Endothelial cell loss and graft survival data have been encouraging. A shortage of human donor corneas restricts utilization in many areas of the world and is driving a search for Keratoplasty alternatives. Further work is needed to expand the donor supply, minimize impediments to adoption, optimize graft survival, and improve refractive predictability.

  • Evolution of Endothelial Keratoplasty.
    Cornea, 2013
    Co-Authors: Francis W. Price, Marianne O. Price
    Abstract:

    Endothelial Keratoplasty has evolved into a popular alternative to penetrating Keratoplasty (PK) for the treatment of Endothelial dysfunction. Although the earliest iterations were challenging and were not widely adopted, the iteration known as Descemet stripping Endothelial Keratoplasty (DSEK) has gained widespread acceptance. DSEK combines a simplified technique for stripping dysfunctional endothelium from the host cornea and microkeratome dissection of the donor tissue, a step now commonly completed in advance by eye bank technicians. Studies show that a newer Endothelial Keratoplasty iteration, known as Descemet membrane Endothelial Keratoplasty (DMEK), provides an even faster and better visual recovery than DSEK does. In addition, DMEK significantly reduces the risk of immunologic graft rejection episodes compared with that in DSEK or in PK. Although the DMEK donor tissue, consisting of the bare endothelium and Descemet membrane without any stroma, is more challenging to prepare and position in the recipient eye, recent improvements in instrumentation and surgical techniques are increasing the ease and the reliability of the procedure. DSEK successfully mitigates 2 of the main liabilities of PK: ocular surface complications and structural problems (including induced astigmatism and perpetually weak wounds), whereas DMEK further mitigates the 2 principal remaining liabilities of PK: immunologic graft reactions and secondary glaucoma from prolonged topical corticosteroid use.

  • Descemet's membrane Endothelial Keratoplasty surgery: update on the evidence and hurdles to acceptance.
    Current opinion in ophthalmology, 2013
    Co-Authors: Marianne O. Price, Francis W. Price
    Abstract:

    Purpose of reviewDescemet's stripping Endothelial Keratoplasty (DSEK) is the most popular treatment for Endothelial dysfunction, but Descemet's membrane Endothelial Keratoplasty (DMEK) now provides better vision with lower risk of immunologic rejection. Although DMEK is more challenging, advances in

  • Endothelial Keratoplasty: a revolution in evolution.
    Survey of ophthalmology, 2012
    Co-Authors: Arundhati Anshu, Marianne O. Price, Donald T.h. Tan, Francis W. Price
    Abstract:

    Endothelial Keratoplasty (EK) is continually evolving both in surgical technique and clinical outcomes. Descemet's stripping Endothelial Keratoplasty (DSEK) has replaced penetrating Keratoplasty (PK) as the treatment of choice for corneal Endothelial dysfunction. It is safe and predictable and offers early visual rehabilitation. Newer iterations include Descemet's membrane Endothelial Keratoplasty, Descemet's membrane automated Endothelial Keratoplasty, and other hybrid techniques. Early data on these newer EK techniques suggests that they provide significantly better visual outcomes compared to DSEK. Initial 5-year survival data indicates that EK is at least comparable to PK, and more widespread survival data is anticipated. Further work is needed to simultaneously optimize visual outcomes, refractive predictability, and Endothelial cell survival, as well as surgical techniques of donor preparation and insertion.

  • secondary graft failure and repeat Endothelial Keratoplasty after descemet s stripping automated Endothelial Keratoplasty
    Ophthalmology, 2011
    Co-Authors: Erik Letko, Marianne O. Price, David A Price, Elissandro M S Lindoso, Francis W. Price
    Abstract:

    Objective To identify the causes of secondary graft failure after Descemet's stripping automated Endothelial Keratoplasty (DSAEK) and to evaluate the clinical outcomes of repeat Endothelial Keratoplasty (REK) in this patient population. Design Retrospective case series. Participants Patients of a private practice Price Vision Group in Indianapolis, Indiana. Methods An initial consecutive series of primary DSAEK procedures performed by a single surgeon between October 2004 and December 2008 was reviewed to identify reasons for and outcomes of REK. Main Outcome Measures Visual acuity and causes of secondary graft failure. Results In a consecutive series of 1050 primary DSAEK procedures, REK for secondary graft failure was performed in 37 eyes (3.5%). The most common reason for REK in this group was unsatisfactory visual acuity relative to the anticipated vision potential (n = 28/37; 76%). Unsatisfactory visual acuity was associated with abnormalities of donor tissue within the pupillary area, including wrinkles or folds, irregular graft thickness, and opacity in the interface. In the 28 eyes with unacceptable visual acuity after initial DSAEK, the median best spectacle-corrected visual acuity (BSCVA) before and after REK was 20/60 (range, 20/40–20/400) and 20/30 (range, 20/20–20/100), respectively, and 75% had BSCVA 20/40 or better after REK. The mean corneal thickness in the 28 eyes regrafted for unsatisfactory vision before and after REK was 809 μm (range, 642–979 μm) and 657 μm (range, 549–801 μm), respectively. Secondary graft failure caused by Endothelial decompensation was the reason for repeat Endothelial graft in the remaining 9 eyes (9/37; 24%). Eight eyes had a history of glaucoma, and 6 of them had glaucoma surgery. An episode of immune rejection reaction was documented in 6 of 9 eyes with Endothelial decompensation. Conclusions Our data suggest that the most common reason for REK after DSAEK is unsatisfactory vision. Patient and physician expectations for visual acuity are higher with DSAEK compared with penetrating Keratoplasty. Repeat Endothelial Keratoplasty can provide improved vision in selected patients. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

David S Rootman - One of the best experts on this subject based on the ideXlab platform.

Hall F Chew - One of the best experts on this subject based on the ideXlab platform.

Mark A. Terry - One of the best experts on this subject based on the ideXlab platform.

  • Step-by-step Descemet's membrane Endothelial Keratoplasty surgery
    Taiwan journal of ophthalmology, 2019
    Co-Authors: Shin-yi Chen, Mark A. Terry
    Abstract:

    With the success of Descemet's stripping automated Endothelial Keratoplasty (DSAEK) technique providing better outcomes in visual prognosis and theoretically lower rejection rate than penetrating Keratoplasty, DSAEK dominated the realm of Endothelial Keratoplasty for the past decade. However, Descemet's membrane Endothelial Keratoplasty (DMEK) has become more and more popular worldwide due to its even lower rejection rate, faster visual recovery, better visual outcome, and lower long-term Endothelial loss. In this article, we demonstrate the techniques and nuances of DMEK surgery in detail for corneal specialists who are beginning their DMEK surgeries.

  • Survey of Experts on Current Endothelial Keratoplasty Techniques.
    Journal of clinical & experimental ophthalmology, 2016
    Co-Authors: Winston Chamberlain, Mark A. Terry, Ariana Austin, Bennie H. Jeng, Jennifer Rose-nussbaumer
    Abstract:

    Objective: To survey cornea specialists’ opinions on different Endothelial Keratoplasty techniques and to gauge the perceived need for and utility of a randomized controlled trial (RCT) comparing them. Methods: A short survey was distributed to a group of cornea specialists at the Endothelial Keratoplasty Group meeting at the American Academy of Ophthalmology meeting in November 2015. Results: Thirty-three of 80 practicing surgeons present at the EKG meeting participated in the survey, yielding a response rate of 41%. Ninety-seven percent (n=32) of our respondents reported performing Descemet’s Stripping Endothelial Keratoplasty (DSEK) regularly, and 70% reported having performed Descemet’s Membrane Endothelial Keratoplasty (DMEK) at least once (n=23). While most respondents (n=26, 79%) thought there was at least some evidence that DMEK is superior to DSEK in terms of visual acuity, there was less certainty about comparing ultrathin-DSEK (UT-DSEK) to DMEK with 48% (n=16) thinking there was at least some evidence of DMEK’s superiority, 6% (n=2) thinking there was at least some evidence of UT-DSEK’s superiority, and 30% (n=10) unsure. Seventy-two percent (n=23) of respondents thought an RCT comparing visual acuity outcomes in UT-DSEK versus DMEK would be at least moderately beneficial, and 82% (n=27) reported they were at least moderately likely to change their EK technique based on the results of said RCT. Conclusion: There is substantial interest in an RCT comparing visual acuity outcomes in UT-DSEK versus DMEK.

  • Evolving indications for Descemet's stripping automated Endothelial Keratoplasty.
    Current opinion in ophthalmology, 2014
    Co-Authors: Peter B. Veldman, Mark A. Terry, Michael D. Straiko
    Abstract:

    PURPOSE OF REVIEW Recent advances in the field of Endothelial transplantation, including increasing acceptance of Descemet's membrane Endothelial Keratoplasty, may alter the indications for Descemet's stripping automated Endothelial Keratoplasty, to a procedure reserved for complex Endothelial disorders. RECENT FINDINGS Recent literature demonstrates that Descemet's membrane Endothelial Keratoplasty provides better and faster visual outcomes and decreased immunologic rejection compared to Descemet's stripping automated Endothelial Keratoplasty. However, Descemet's membrane Endothelial Keratoplasty may be more challenging in the management of a number of more complex Endothelial disorders. While the literature on complex Descemet's membrane Endothelial Keratoplasty is limited, the utility of Descemet's stripping automated Endothelial Keratoplasty has been validated in the management of Endothelial dysfunction in the setting of a number of comorbid conditions including prior penetrating Keratoplasty, prior glaucoma surgery, iridocorneal Endothelial syndrome, aniridia, aphakia, and anterior chamber intraocular lenses, among others. SUMMARY The increasing adoption of Descemet's membrane Endothelial keratoplast is changing the practice of Endothelial Keratoplasty. However, limitations of the Descemet's membrane Endothelial Keratoplasty procedure have also served to crystallize the essential role of Descemet's stripping automated Endothelial Keratoplasty in many complex Endothelial Keratoplasty scenarios. This article will review indications for Endothelial Keratoplasty, along with the current evidence for Descemet's stripping automated Endothelial Keratoplasty and Descemet's membrane Endothelial Keratoplasty in their management.

  • Donor cell density and Endothelial Keratoplasty
    The British journal of ophthalmology, 2010
    Co-Authors: Christopher G. Stoeger, Mark A. Terry
    Abstract:

    We read with interest the recent article by Amato et al , ‘Pre-cut donor tissue for Descemet stripping automated Keratoplasty: anterior hinged lamella on versus off’.1 We congratulate Dr Amato and his colleagues for their contribution to the rapidly changing field of Endothelial Keratoplasty (EK). In their discussion, however, Dr Amato and colleagues state that a minimum Endothelial cell density of 2500/mm2 should be the requirement for donor corneas used for Decemet's stripping automated Endothelial Keratoplasty (DSAEK). This …

  • Endothelial Keratoplasty: improvement of vision after healthy donor tissue exchange.
    Cornea, 2008
    Co-Authors: Edwin S. Chen, Neda Shamie, Mark A. Terry, Karen L. Hoar
    Abstract:

    OBJECTIVE To report 3 cases of graft exchange by using a microkeratome-prepared donor tissue in place of a manually prepared donor tissue for inadequate postoperative visual acuity after deep lamellar Endothelial Keratoplasty and to discuss possible etiologies. METHODS Prospective, observational case series. The patients were 3 consecutive patients who underwent Endothelial graft replacement for unsatisfactory vision after initial deep lamellar Endothelial Keratoplasty. This is a review of clinical findings in 3 cases of Endothelial Keratoplasty that underwent graft exchange for unacceptable vision after deep lamellar Endothelial Keratoplasty. RESULTS Two patients benefited from graft exchange by using a microkeratome-prepared donor in place of a manually prepared donor with improvement in best spectacle-corrected visual acuity and 1 did not because of recipient bed irregularities. Vision improved in this patient with penetrating Keratoplasty. CONCLUSIONS Endothelial Keratoplasty results in rapid visual recovery and excellent vision. However, fewer eyes achieve 20/20 vision than with full-thickness penetrating Keratoplasty. This report shows that some patients with suboptimal vision after Endothelial Keratoplasty felt to be caused by interface optical problems may benefit from either graft exchange or penetrating Keratoplasty.