Keratoplasty

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

  • outcome and histopathology of secondary penetrating Keratoplasty graft failure managed by descemet membrane endothelial Keratoplasty
    Cornea, 2017
    Co-Authors: Itay Lavy, Thomas M Muller, Vasilios S. Liarakos, Jack S Parker, Robert M Verdijk, Marieke Bruinsma, Perry S Binder, Gerrit R J Melles
    Abstract:

    Purpose:To describe the clinical outcome and histopathology of Descemet membrane endothelial Keratoplasty (DMEK) performed for secondary graft failure after penetrating Keratoplasty (PK).Methods:A total of 11 eyes from 10 patients who underwent DMEK for secondary PK graft failure at a tertiary refer

  • more efficient use of donor corneal tissue with descemet membrane endothelial Keratoplasty dmek two lamellar Keratoplasty procedures with one donor cornea
    British Journal of Ophthalmology, 2010
    Co-Authors: Jessica T Lie, Jacqueline Van Der Wees, Lisanne Ham, E Groeneveldvan A Beek, Gerrit R J Melles
    Abstract:

    Since 1998, we have published several techniques for endothelial Keratoplasty, popularised as deep lamellar endothelial Keratoplasty (DLEK), Descemet stripping (automated) endothelial Keratoplasty (DSEK/DSAEK) and Descemet membrane endothelial Keratoplasty (DMEK).1–3 All of these techniques potentially provide the possibility of using a single donor cornea for more than one recipient: because only the posterior corneal layers are used in endothelial Keratoplasty, the remaining anterior cornea may potentially be used in an anterior lamellar Keratoplasty procedure. With the advent of DMEK, for which Descemet membrane with its endothelium is stripped from a donor corneo-scleral rim to subsequently become transplanted, the complete donor stroma is left intact for other different transplantation purposes,4 including a “full-stromal-thickness” deep anterior lamellar Keratoplasty (DALK). However, the preparation of thin Descemet grafts may …

  • endothelial Keratoplasty dsek dsaek or dmek the thinner the better
    Current Opinion in Ophthalmology, 2009
    Co-Authors: Isabel Dapena, Lisanne Ham, Gerrit R J Melles
    Abstract:

    Purpose of reviewEndothelial Keratoplasty has been adopted worldwide as an alternative to penetrating Keratoplasty in the treatment of corneal endothelial disorders. Descemet stripping (automated) endothelial Keratoplasty (DSEK/DSAEK) may be the current standard, whereas Descemet membrane endothelia

  • endothelial cell density after posterior lamellar Keratoplasty melles techniques 3 years follow up
    American Journal of Ophthalmology, 2004
    Co-Authors: Bart T H Van Dooren, W. Houdijn Beekhuis, Paul G H Mulder, Carla P Nieuwendaal, Gerrit R J Melles
    Abstract:

    Abstract Purpose To report the midterm endothelial cell density measurements after posterior lamellar Keratoplasty (Melles techniques). Design Cohort study. Methods Fifteen consecutive eyes of 15 patients in whom a posterior lamellar Keratoplasty procedure was performed for pseudophakic bullous keratopathy or Fuchs' endothelial dystrophy were evaluated. In 11 corneas the donor tissue was inserted through a 9.0-mm sclerocorneal pocket incision (technique A); in four cases the donor was folded and inserted through a 5.0-mm incision (technique B). Specular microscopy was performed at 6, 12, 24, and 36 months after surgery, to measure the endothelial cell density. Results Mean postoperative endothelial cell density averaged 2,126 cells/mm 2 (±548) at 6 months, 1,859 cells/mm 2 (±477) at 12 months, 1,385 cells/mm 2 (±451) at 24 months, and 1,047 cells/mm 2 (±425) at 36 months. Conclusion In posterior lamellar Keratoplasty, the donor corneal endothelium showed a decrease in cell density similar to that after conventional full-thickness penetrating Keratoplasty.

  • endothelial cell density after deep anterior lamellar Keratoplasty melles technique
    American Journal of Ophthalmology, 2004
    Co-Authors: Bart T H Van Dooren, Gerrit R J Melles, Paul G H Mulder, Carla P Nieuwendaal, Houdijn W Beekhuis
    Abstract:

    Abstract Purpose To measure the recipient endothelial cell loss after the Melles technique for deep anterior lamellar Keratoplasty. Methods In 21 eyes of 21 patients, a deep anterior lamellar Keratoplasty procedure was performed. Before surgery and at 6, 12, and 24 months after surgery, specular microscopy was performed to evaluate the endothelial cell density. For each postoperative time interval, the mean endothelial cell loss relative to the preoperative value was calculated. Results Mean postoperative endothelial cell loss averaged 283 cells/mm 2 (± 293) at 6 months, 335 cells/mm 2 (± 309) at 12 months, and 421 cells/mm 2 (± 316) at 24 months. Estimate relative endothelial cell density losses obtained by mixed model analysis of variance were 11.1%, 2.0%, and 1.2%, respectively, each time compared with its previous measurement point. Second order comparisons showed that the loss within the first 6 months was significantly higher than after 6 months. Conclusion In deep anterior lamellar Keratoplasty, the recipient corneal endothelium showed a small initial drop in endothelial cell density followed by a physiologic rate of cell loss. Cell survival after lamellar Keratoplasty may be expected to be better when compared with that following penetrating Keratoplasty.

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

  • ek dlek dsek dmek new frontier in cornea surgery
    Annual Review of Vision Science, 2017
    Co-Authors: Marianne O Price, Pankaj Gupta, Jonathan H Lass, Francis W Price
    Abstract:

    Endothelial Keratoplasty (EK) has revolutionized treatment of corneal endothelial dysfunction. Compared with penetrating Keratoplasty (PK), EK provides faster and more reliable visual rehabilitation while maintaining the eye's structural integrity. The number of EK procedures is growing annually and surpassed PK in the United States in 2012. The most widely used iteration, Descemet stripping endothelial Keratoplasty (DSEK), implants healthy donor endothelium, Descemet membrane, and posterior stroma. Descemet membrane endothelial Keratoplasty (DMEK) eliminates the donor stromal layer. Although more surgically challenging than DSEK, DMEK provides even faster visual rehabilitation and reduced risk of immunologic rejection, so its use is growing. Potential future alternatives to EK that could help address the unmet demand for donor corneas include removing central guttae and regenerating a central endothelial cell layer from healthy peripheral cells in patients with Fuchs' dystrophy or injecting cultured human corneal endothelial cells to rehabilitate eyes without residual healthy endothelium.

  • Prevention and Management of Pupil Block After Descemet Membrane Endothelial Keratoplasty.
    Cornea, 2016
    Co-Authors: Andres A. Gonzalez, Francis W Price, Marianne O Price, Matthew T. Feng
    Abstract:

    Purpose:To assess frequency, associations, and outcomes of full air fill after Descemet membrane endothelial Keratoplasty (DMEK).Methods:This retrospective study reviewed 368 consecutive DMEK cases performed to treat Fuchs dystrophy, bullous keratopathy, or failed Keratoplasty. Primary outcomes were

  • graft failure and intraocular pressure control after Keratoplasty in iridocorneal endothelial syndrome
    American Journal of Ophthalmology, 2015
    Co-Authors: Desmond Tunglien Quek, Chee Wai Wong, Tina T Wong, Ching Lin Ho, Hla Myint Htoon, Francis W Price, Marianne O Price, Jodhbir S. Mehta
    Abstract:

    Purpose To describe and compare graft survival and intraocular pressure (IOP) control after penetrating Keratoplasty (PK) and Descemet stripping automated endothelial Keratoplasty (DSAEK) in eyes with iridocorneal endothelial (ICE) syndrome. Design Retrospective case series. Methods Multicenter study conducted at the Singapore National Eye Centre (SNEC) and Price Vision Group. Twenty-nine consecutive eyes with ICE syndrome that underwent Keratoplasty between 1991 and 2011 were identified from the SNEC transplant database and Price Vision Group patient database and the following data extracted: demographics, graft failure, IOP indices, and glaucoma treatment pre- and postKeratoplasty. The main outcome measures were graft failure and need for additional IOP-lowering treatment after Keratoplasty. Results The mean follow-up duration was 7.0 ± 4.9 years in the PK group (n = 17) and 4.0 ± 2.6 years in the DSAEK group (n = 12). After a mean of 4.1 ± 3.1 years, 37.9% of grafts (11/29) failed: 7 PK compared to 4 DSAEK ( P  = .72). The graft failure rate was 50% in eyes with preKeratoplasty glaucoma surgery vs 31.6% in those without ( P  = .43). Additional glaucoma treatment was required in 37.9% of eyes (11/29): 41.2% of PK eyes and 50% of DSAEK eyes ( P  = .28) Eyes that had undergone glaucoma surgery before Keratoplasty were less likely to require escalation of IOP-lowering therapy postKeratoplasty (9.1% vs 50%, P  = .03). Conclusions One-third of grafts failed after Keratoplasty for ICE syndrome at a mean duration of 4 years and additional IOP-lowering treatment was required in 37.9%. Both PK and DSAEK had similar outcomes with regard to graft failure and IOP control.

  • 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

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

  • ek dlek dsek dmek new frontier in cornea surgery
    Annual Review of Vision Science, 2017
    Co-Authors: Marianne O Price, Pankaj Gupta, Jonathan H Lass, Francis W Price
    Abstract:

    Endothelial Keratoplasty (EK) has revolutionized treatment of corneal endothelial dysfunction. Compared with penetrating Keratoplasty (PK), EK provides faster and more reliable visual rehabilitation while maintaining the eye's structural integrity. The number of EK procedures is growing annually and surpassed PK in the United States in 2012. The most widely used iteration, Descemet stripping endothelial Keratoplasty (DSEK), implants healthy donor endothelium, Descemet membrane, and posterior stroma. Descemet membrane endothelial Keratoplasty (DMEK) eliminates the donor stromal layer. Although more surgically challenging than DSEK, DMEK provides even faster visual rehabilitation and reduced risk of immunologic rejection, so its use is growing. Potential future alternatives to EK that could help address the unmet demand for donor corneas include removing central guttae and regenerating a central endothelial cell layer from healthy peripheral cells in patients with Fuchs' dystrophy or injecting cultured human corneal endothelial cells to rehabilitate eyes without residual healthy endothelium.

  • Prevention and Management of Pupil Block After Descemet Membrane Endothelial Keratoplasty.
    Cornea, 2016
    Co-Authors: Andres A. Gonzalez, Francis W Price, Marianne O Price, Matthew T. Feng
    Abstract:

    Purpose:To assess frequency, associations, and outcomes of full air fill after Descemet membrane endothelial Keratoplasty (DMEK).Methods:This retrospective study reviewed 368 consecutive DMEK cases performed to treat Fuchs dystrophy, bullous keratopathy, or failed Keratoplasty. Primary outcomes were

  • graft failure and intraocular pressure control after Keratoplasty in iridocorneal endothelial syndrome
    American Journal of Ophthalmology, 2015
    Co-Authors: Desmond Tunglien Quek, Chee Wai Wong, Tina T Wong, Ching Lin Ho, Hla Myint Htoon, Francis W Price, Marianne O Price, Jodhbir S. Mehta
    Abstract:

    Purpose To describe and compare graft survival and intraocular pressure (IOP) control after penetrating Keratoplasty (PK) and Descemet stripping automated endothelial Keratoplasty (DSAEK) in eyes with iridocorneal endothelial (ICE) syndrome. Design Retrospective case series. Methods Multicenter study conducted at the Singapore National Eye Centre (SNEC) and Price Vision Group. Twenty-nine consecutive eyes with ICE syndrome that underwent Keratoplasty between 1991 and 2011 were identified from the SNEC transplant database and Price Vision Group patient database and the following data extracted: demographics, graft failure, IOP indices, and glaucoma treatment pre- and postKeratoplasty. The main outcome measures were graft failure and need for additional IOP-lowering treatment after Keratoplasty. Results The mean follow-up duration was 7.0 ± 4.9 years in the PK group (n = 17) and 4.0 ± 2.6 years in the DSAEK group (n = 12). After a mean of 4.1 ± 3.1 years, 37.9% of grafts (11/29) failed: 7 PK compared to 4 DSAEK ( P  = .72). The graft failure rate was 50% in eyes with preKeratoplasty glaucoma surgery vs 31.6% in those without ( P  = .43). Additional glaucoma treatment was required in 37.9% of eyes (11/29): 41.2% of PK eyes and 50% of DSAEK eyes ( P  = .28) Eyes that had undergone glaucoma surgery before Keratoplasty were less likely to require escalation of IOP-lowering therapy postKeratoplasty (9.1% vs 50%, P  = .03). Conclusions One-third of grafts failed after Keratoplasty for ICE syndrome at a mean duration of 4 years and additional IOP-lowering treatment was required in 37.9%. Both PK and DSAEK had similar outcomes with regard to graft failure and IOP control.

  • 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

Philip Maier - One of the best experts on this subject based on the ideXlab platform.

  • outcomes of descemet membrane endothelial Keratoplasty descemet stripping automated endothelial Keratoplasty and penetrating Keratoplasty from a single centre study
    Graefes Archive for Clinical and Experimental Ophthalmology, 2016
    Co-Authors: Sonja Heinzelmann, Daniel Bohringer, Philipp Eberwein, Thomas Reinhard, Philip Maier
    Abstract:

    Purpose According to some pioneer surgeons, lamellar endothelial Keratoplasty techniques (EK), including Descemet membrane endothelial Keratoplasty (DMEK) and Descemet stripping automated endothelial Keratoplasty (DSAEK), yield excellent clinical results. However, there is a lack of studies with high levels of evidence and results of large national Keratoplasty registers are contradictory. Therefore, two large cohorts of DMEK and DSAEK procedures are compared to a cohort of penetrating Keratoplasty (PK).

  • outcomes of descemet membrane endothelial Keratoplasty descemet stripping automated endothelial Keratoplasty and penetrating Keratoplasty from a single centre study
    Graefes Archive for Clinical and Experimental Ophthalmology, 2016
    Co-Authors: Sonja Heinzelmann, Daniel Bohringer, Philipp Eberwein, Thomas Reinhard, Philip Maier
    Abstract:

    According to some pioneer surgeons, lamellar endothelial Keratoplasty techniques (EK), including Descemet membrane endothelial Keratoplasty (DMEK) and Descemet stripping automated endothelial Keratoplasty (DSAEK), yield excellent clinical results. However, there is a lack of studies with high levels of evidence and results of large national Keratoplasty registers are contradictory. Therefore, two large cohorts of DMEK and DSAEK procedures are compared to a cohort of penetrating Keratoplasty (PK). The study reports 868 Keratoplasty procedures at a single centre (694 eyes with Fuchs endothelial dystrophy (FED) and 174 with bullous keratopathy (BK)). Patients underwent DMEK (450 eyes), DSAEK (89 eyes), or PK (329 eyes). Postoperative visual acuity, endothelial cell density (ECD), rate of regrafting, and rejections were recorded. Visual acuity recovers faster and to a greater extent in EK compared to PK. DMEK performs better than DSAEK. ECD drops faster initially for EK compared to PK. In EK the rate of regrafting is higher than in PK (7 % in DMEK, 20 % in DSAEK and 2 % in PK in FED). The rejection rate is lowest following DMEK (7 % after DMEK, 21 % after DSAEK and 18 % after PK in FED). In contrast to recent reports from national Keratoplasty registers, the overall clinical outcome of EK in FED and BK is superior to PK. Including ocular comorbidities and learning curves, these data reflect a realistic setting for comparing the different Keratoplasty techniques. Corneal surgeons may be encouraged to preferentially use DMEK in FED and BK.

  • Influence of Donor Characteristics on Descemet Membrane Endothelial Keratoplasty
    Cornea, 2014
    Co-Authors: Sonja Heinzelmann, Daniel Bohringer, Philipp Eberwein, Thomas Reinhard, Silja Hüther, Philip Maier
    Abstract:

    Purpose:Penetrating Keratoplasty is being replaced by posterior lamellar techniques like Descemet stripping automated endothelial Keratoplasty or Descemet membrane endothelial Keratoplasty (DMEK) for the surgical treatment of patients with endothelial insufficiency. Although DMEK leads to the best v

Sonja Heinzelmann - One of the best experts on this subject based on the ideXlab platform.

  • outcomes of descemet membrane endothelial Keratoplasty descemet stripping automated endothelial Keratoplasty and penetrating Keratoplasty from a single centre study
    Graefes Archive for Clinical and Experimental Ophthalmology, 2016
    Co-Authors: Sonja Heinzelmann, Daniel Bohringer, Philipp Eberwein, Thomas Reinhard, Philip Maier
    Abstract:

    Purpose According to some pioneer surgeons, lamellar endothelial Keratoplasty techniques (EK), including Descemet membrane endothelial Keratoplasty (DMEK) and Descemet stripping automated endothelial Keratoplasty (DSAEK), yield excellent clinical results. However, there is a lack of studies with high levels of evidence and results of large national Keratoplasty registers are contradictory. Therefore, two large cohorts of DMEK and DSAEK procedures are compared to a cohort of penetrating Keratoplasty (PK).

  • outcomes of descemet membrane endothelial Keratoplasty descemet stripping automated endothelial Keratoplasty and penetrating Keratoplasty from a single centre study
    Graefes Archive for Clinical and Experimental Ophthalmology, 2016
    Co-Authors: Sonja Heinzelmann, Daniel Bohringer, Philipp Eberwein, Thomas Reinhard, Philip Maier
    Abstract:

    According to some pioneer surgeons, lamellar endothelial Keratoplasty techniques (EK), including Descemet membrane endothelial Keratoplasty (DMEK) and Descemet stripping automated endothelial Keratoplasty (DSAEK), yield excellent clinical results. However, there is a lack of studies with high levels of evidence and results of large national Keratoplasty registers are contradictory. Therefore, two large cohorts of DMEK and DSAEK procedures are compared to a cohort of penetrating Keratoplasty (PK). The study reports 868 Keratoplasty procedures at a single centre (694 eyes with Fuchs endothelial dystrophy (FED) and 174 with bullous keratopathy (BK)). Patients underwent DMEK (450 eyes), DSAEK (89 eyes), or PK (329 eyes). Postoperative visual acuity, endothelial cell density (ECD), rate of regrafting, and rejections were recorded. Visual acuity recovers faster and to a greater extent in EK compared to PK. DMEK performs better than DSAEK. ECD drops faster initially for EK compared to PK. In EK the rate of regrafting is higher than in PK (7 % in DMEK, 20 % in DSAEK and 2 % in PK in FED). The rejection rate is lowest following DMEK (7 % after DMEK, 21 % after DSAEK and 18 % after PK in FED). In contrast to recent reports from national Keratoplasty registers, the overall clinical outcome of EK in FED and BK is superior to PK. Including ocular comorbidities and learning curves, these data reflect a realistic setting for comparing the different Keratoplasty techniques. Corneal surgeons may be encouraged to preferentially use DMEK in FED and BK.

  • Influence of Donor Characteristics on Descemet Membrane Endothelial Keratoplasty
    Cornea, 2014
    Co-Authors: Sonja Heinzelmann, Daniel Bohringer, Philipp Eberwein, Thomas Reinhard, Silja Hüther, Philip Maier
    Abstract:

    Purpose:Penetrating Keratoplasty is being replaced by posterior lamellar techniques like Descemet stripping automated endothelial Keratoplasty or Descemet membrane endothelial Keratoplasty (DMEK) for the surgical treatment of patients with endothelial insufficiency. Although DMEK leads to the best v

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