Articles de revues : « DMEK »

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Oganesyan, Oganes G., A. A. Grdikanyan, S. S. Yakovleva et V. R. Getadaryan. « THE PARTIAL DESCEMET'S STRIPPING WITH TRANSPLANTATION OF DESCEMET'S TRANSPLANT UNDER ENDOTHELIAL DYSTROPHY OF CORNEA ». Medical Journal of the Russian Federation 23, n^o 5 (15 octobre 2017) : 248–53. http://dx.doi.org/10.18821/0869-2106-2017-23-5-248-253.

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The DMEK technique is applied five times more rarely than DS(A)EK despite that DMEK provides higher functional result. The main causes are technical "convolution" of implementation, long period of training, accompanied by prolonged operations, higher reject control of donor's tissue, increased rate of dependency of endothelium and mismatch of transplant. Therefore, an efficient technique is needed similar to DMEK though simpler than DMEK.The purpose of study. To analyze the results of implantation of Descemet's transplant (DMET) in patients with endothelium dystrophy of cornea (Fuchs) on the basis of limited clinical observations.Material of study. In two years, DMET was implemented to 12 patients. The study included 6 patients with average age of 60±18 years (from 29 to 80 years). All female patients had primary endothelial dystrophy and one male patient had secondary endothelial dystrophy. The visual acuity prior to DMET in average made up to 0,2±0,2 (from 0,01 to 0,5). The average CTR according optical coherent eye tomography made up to 685±53 µm (from 622 to 749 µm). Results. Within available periods of observation, resorption of edema of cornea takes place in 4 patients (67%) and visual acuity increased from average 0,2±0,1 to 0,45±0,3. In various periods density of endothelium cells varied from 549 to 689 kl per mm2. The indices of optical coherent eye tomography decreased from pre-operational 685±53 µm to 553±15 µm. Conclusion. The results testify efficiency of DMET. The period of restoration of transparency of cornea can vary from 1 to 6 months. The indices of density of endothelium cells are inferior to indices after DMEK. Also, DMET is ineffective in case of secondary dystrophy and at most efficient on previously non-operated eyes.

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Giebel, Arthur W. « DMEK ». International Ophthalmology Clinics 53, n^o 1 (2013) : 1–14. http://dx.doi.org/10.1097/iio.0b013e31827744c4.

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Morelli, Alberto, Rosangela Ferrandina, Eleonora Favuzza, Michela Cennamo et Rita Mencucci. « 3D Visualization System in Descemet Membrane Endothelial Keratoplasty (DMEK) : A Six-Month Comparison with Conventional Microscope ». Journal of Clinical Medicine 11, n^o 15 (25 juillet 2022) : 4312. http://dx.doi.org/10.3390/jcm11154312.

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Background: To compare the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) surgery using the three-dimensional (3D) display system NGENUITY to DMEK surgery performed with the traditional microscope (TM) in patients affected by Fuchs Endothelial Corneal Disease (FECD). Methods: Retrospective comparative study of 40 pseudophakic eyes of 40 patients affected by FECD who underwent DMEK surgery. Twenty patients (3D group) were operated on using the 3D display system and 20 patients (TM group) were operated on using the traditional microscope. Best spectacle corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD) and corneal densitometry (CD) values were documented before and at 1, 3 and 6 months after DMEK. Intra- and postoperative complications were recorded. Results: The baseline assessments did not differ between the two groups (p > 0.05). Global surgical time and time to perform descemetorhexis were significantly lower in the TM group (p = 0.04 and p = 0.02, respectively). BSCVA, CCT, ECD and CD values did not differ significantly in the two groups at all follow-ups (p > 0.05). Complication rate was similar between the two groups. Conclusion: Three-dimensional display systems can be securely employed in DMEK surgery considering the satisfactory clinical outcomes, including Scheimpflug CD. Nevertheless, the slightly longer surgical time of the 3D DMEKs may lead to surgeons’ hesitancy. The main advantages of the heads-up approach may be the improved ergonomic comfort during surgery and the utility of assistants in surgical training.

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Perez, AlfonsoVasquez, Mehran Zarei-Ghanavati et Christopher Liu. « DMEK calling ». Journal of Ophthalmic and Vision Research 11, n^o 4 (2016) : 343. http://dx.doi.org/10.4103/2008-322x.194067.

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Gorovoy, Mark S. « DMEK Complications ». Cornea 33, n^o 1 (janvier 2014) : 101–4. http://dx.doi.org/10.1097/ico.0000000000000023.

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Semler-Collery, Axelle, Florian Bloch, George Hayek, Christophe Goetz et Jean Marc Perone. « Comparison of triple-DMEK to pseudophakic-DMEK : A cohort study of 95 eyes ». PLOS ONE 17, n^o 5 (12 mai 2022) : e0267940. http://dx.doi.org/10.1371/journal.pone.0267940.

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Previous comparative studies show that triple Descemet membrane endothelial keratoplasty (DMEK) (i.e. phacoemulsification followed immediately by DMEK) has either equivalent or better visual outcomes than DMEK in pseudophakic patients. To resolve this discrepancy, a retrospective cohort study was conducted. All consecutive patients with Fuchs Endothelial Corneal Dystrophy who underwent triple or pseudophakic DMEK in 2015–2019 in a tertiary-care hospital (France) and were followed for >12 months were compared in terms of best spectacle-corrected visual acuity (BSCVA), final refractive outcomes, and endothelial-cell loss at 12 months as well as rebubbling rates. The triple-DMEK (40 eyes, 34 patients) and pseudophakic-DMEK (55 eyes, 43 patients) groups were similar in terms of age and other baseline variables. They also did not differ in final BSCVA (both 0.03 logMAR), final endothelial-cell loss (54% vs. 48%), or astigmatism (-1.25 vs. -1 D). At 12 months, triple-DMEK associated with significantly smaller residual hyperopia (0.75 vs. 1 D; p = 0.04) and spherical equivalence (0 vs. 0.5 D; p = 0.02). Triple-DMEK also tended to associate with more frequent rebubbling (40% vs. 24%, p = 0.09). In conclusion, while triple-DMEK and pseudophakic-DMEK achieved similar visual acuity improvement, triple-DMEK was superior in terms of final sphere and spherical refraction but also tended to have higher complication rates.

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Oganesyan, Oganes G., P. V. Makarov, A. A. Grdikanyan, V. R. Getadaryan et S. V. Milash. « THE PARTIAL TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM (½ AND ¼ DMEK) ». Medical Journal of the Russian Federation 24, n^o 2 (15 avril 2018) : 78–82. http://dx.doi.org/10.18821/0869-2106-2018-24-2-78-82.

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The lamellar keratoplasty is the first operation of choice under selective pathology of cornea. In view of satisfactory results of endothelium surgery similar operations are implemented at more earlier stages that increases need in donor tissue. The life-span of population increases hence number of patients in need of cornea transplantation also increases and number of intact cadaver corneas decreases because of stable increasing of number of surgical interventions at the frontal section of eye. The purpose of study is to analyze operations of partial transplantation of Descemet's membrane with endothelium (½ DMEK and ¼ DMEK). Material and methods. The analysis was applied to the results of 10 operations ½ DMEK (semi-DMEK, hemi-DMEK) and 10 operations ¼ DMEK, implemented at eyes of 20 patients with primary endothelium dystrophy. The average age of patients made up to 64,9±10,4 years. The average visual acuity prior to implementation of partial DMEK amounted to 0,14 ± 0,08, average central thickness of cornea, according data of optical coherent tomography, made up to 669 ± 91 мкм. Results. In 16 out of 20 cases of partial DMEK, restoration of transparency of cornea, resorption of edema and increasing of visual acuity was achieved. In other 4 cases, during one week after partial DMEK, a subtotal DMEK was implemented. In 16 cases, average visual acuity increased up to 0,8 ± 0,3 three months later after operation. Conclusion. The techniques of partial transplantation of Descemet's membrane with endothelium (¼ DMEK и ½ DMEK) are efficient for treatment of primary endothelium pathology of cornea and permit to apply donor's material as much as possible rationally.

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Lohmann, Tibor, Sabine Baumgarten, Niklas Plange, Peter Walter et Matthias Fuest. « Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness ». Graefe's Archive for Clinical and Experimental Ophthalmology 259, n^o 9 (11 mai 2021) : 2731–41. http://dx.doi.org/10.1007/s00417-021-05203-2.

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Abstract Purpose To determine retinal thickness (RT) changes and the incidence of macular edema after uncomplicated Descemet membrane endothelial keratoplasty (DMEK-ME) in patients without ME risk factors. Methods In this retrospective study, 107 pseudophakic eyes of 74 patients with Fuchs endothelial dystrophy (FED) (79.4%) or bullous keratopathy (BK) (20.6%) underwent DMEK surgery between 2016 and 2019 at the Department of Ophthalmology, RWTH Aachen University. Patients with intra- or postoperative complications as well as pre-existing risk factors for ME were excluded. Macular spectral-domain optical coherence tomography (SD-OCT) and best spectacle-corrected visual acuity (BSCVA) measurements were performed before, 1 week, 1 month, and 6 months after surgery. Retinal thickness (RT) was analyzed in the central foveal 1 mm (CSF), parafoveal 3 mm and 6 mm subfield. Results Eight eyes (7.5%) developed DMEK-ME 1 month after surgery. Six DMEK-ME eyes (75%) were rebubbled, compared with 31.3% (31 of 99; P = 0.02) of the non DMEK-ME eyes. DMEK-ME eyes had a significantly thicker CSF 1 month after surgery (432.0 ± 97.6 μm) compared with non-DMEK-ME eyes (283.7 ± 22.2 μm; P = 0.01). The other subfields and time points showed no significant RT changes. DMEK-ME significantly impaired BSCVA (0.38 ± 0.92 logMAR) only 1 month after surgery in comparison to the non DMEK-ME eyes (0.23 ± 0.87 logMAR, P = 0.015). Conclusion Excluding systemic and surgery-related risk factors, rebubbling increases the risk of DMEK-ME. Performing a CSF scan 1 month after surgery, particularly in rebubbled eyes, efficiently detects DMEK-ME and allows the prompt initiation of treatment, e.g., topical corticosteroid and non-steroidal (NSAID) eye drops.

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Romano, Vito, Luca Pagano, Kunal A. Gadhvi, Giulia Coco, Mitchell Titley, Matthew Thomas Fenech, Stefano Ferrari, Hannah J. Levis, Mohit Parekh et Stephen Kaye. « Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK ». BMJ Open Ophthalmology 5, n^o 1 (octobre 2020) : e000546. http://dx.doi.org/10.1136/bmjophth-2020-000546.

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ObjectiveTo compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK).Methods and analysisComparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures.Results56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01.ConclusionPl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.

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Terry, Mark A., Michael D. Straiko, Peter B. Veldman, Julia C. Talajic, Cor VanZyl, Christopher S. Sales et Zachary M. Mayko. « Standardized DMEK Technique ». Cornea 34, n^o 8 (août 2015) : 845–52. http://dx.doi.org/10.1097/ico.0000000000000479.

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Schmidt, Manuela, Andreas Mößner, Renate Wiedemann, Christian Girbardt et Jan Darius Unterlauft. « DMEK à chaud ». Der Ophthalmologe 117, n^o 1 (11 avril 2019) : 69–72. http://dx.doi.org/10.1007/s00347-019-0888-0.

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Bhandari, Vipul, Jagdeesh K. Reddy, Kirti Relekar et Vijayalakshmi Prabhu. « Descemet’s Stripping Automated Endothelial Keratoplasty versus Descemet’s Membrane Endothelial Keratoplasty in the Fellow Eye for Fuchs Endothelial Dystrophy : A Retrospective Study ». BioMed Research International 2015 (2015) : 1–7. http://dx.doi.org/10.1155/2015/750567.

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Aim. To evaluate visual outcome and endothelial cell density (ECD) after Descemet’s Membrane Endothelial Keratoplasty (DMEK) in comparison with Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in the fellow eye for Fuchs endothelial dystrophy (FED).Design. Single-centre, retrospective case series.Methods. 30 eyes of 30 patients undergoing DMEK, who completed a 1-year follow-up, were compared with 30 fellow eyes which underwent DSAEK for bilateral FED. Main outcome measures studied included Best Corrected Visual Acuity (BCVA) and ECD during a 1-year follow-up period.Results. BCVA improved from 0.78 ± 0.35 logMAR, and 0.73 ± 0.31 logMAR before surgery to 0.22 ± 0.1 logMAR and 0.35 ± 0.12 logMAR 6 months after DMEK and DSEK, respectively (P<0.001). At one year after surgery, the BCVA was maintained at 0.21 ± 0.12 logMAR and 0.34 ± 0.1 logMAR, respectively, after DMEK and DSAEK. A statistically better visual outcome was observed after DMEK compared to DSAEK (P<0.05) in fellow eyes.Conclusions. DMEK provided better visual rehabilitation when compared to DSAEK. Nevertheless, there were no significant differences with regard to the ECD within a 1-year follow-up.

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Marques, Raquel Esteves, Paulo Silva Guerra, David Cordeiro Sousa, Ana Inês Gonçalves, Ana Miguel Quintas et Walter Rodrigues. « DMEK versus DSAEK for Fuchs’ endothelial dystrophy : A meta-analysis ». European Journal of Ophthalmology 29, n^o 1 (16 avril 2018) : 15–22. http://dx.doi.org/10.1177/1120672118757431.

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Purpose: To compare the safety and efficacy profiles of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in adult patients with Fuchs’ endothelial dystrophy. Methods: Electronic database search on MEDLINE and CENTRAL from inception to August 2017. We included all comparative studies of DMEK versus DSAEK in patients with diagnosed Fuchs’ endothelial dystrophy. Studies assessing rescue procedures were excluded to minimize bias. Primary outcome: mean difference in best-corrected visual acuity (BCVA) at 3, 6, and 12 months postoperatively. Secondary outcomes: rates of graft primary failure, rejection, and rebubbling; other graft-related issues; mean difference in endothelial cell density; subjective visual outcomes; and patient satisfaction. Results: A total of 10 retrospective studies of moderate methodological quality were included (n = 947 eyes, 646 DMEK). BCVA was better with DMEK at all evaluated time points (0.16 logMAR at 12 months) comparing to DSAEK (0.30 logMAR; p < 0.001). DMEK had a 60% lower rate of rejection (risk ratio (RR) 0.4, 95% CI (0.24, 0.67), p = 0.0005), but required more rebubblings (RR = 2.48, 95% CI (1.32, 4.64), p = 0.005). DMEK had more primary graft failures and less endothelial cell density loss, but statistical difference was not reached. More patients were satisfied after DMEK (odds ratio = 10.29, 95% CI (3.55, 29.80), p < 0.0001). Conclusion: DMEK showed better postoperative results regarding BCVA, patient satisfaction, and graft-related issues. However, the small number of studies with short follow-up times and other methodological issues prompt us to interpret these results carefully.

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Zygoura, Vasiliki, Lamis Baydoun, Lisanne Ham, Vincent J. A. Bourgonje, Korine van Dijk, Jessica T. Lie, Isabel Dapena, Silke Oellerich et Gerrit R. J. Melles. « Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) for Fuchs endothelial corneal dystrophy : 6 months clinical outcome ». British Journal of Ophthalmology 102, n^o 10 (17 janvier 2018) : 1425–30. http://dx.doi.org/10.1136/bjophthalmol-2017-311398.

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Background/aimTo assess the clinical outcome of the first series of Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK), a potential hybrid technique between ‘descemetorhexis only’ and conventional, circular DMEK.MethodsProspective interventional case series at a tertiary referral centre. Twelve eyes of 12 patients with central Fuchs endothelial corneal dystrophy underwent Quarter-DMEK, that is, transplantation of one quadrant of a full-diameter DMEK graft, and were evaluated for best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications up to 6 months postoperatively.ResultsAt 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5), 11/12 (92%) of ≥20/25 (≥0.8) and 6/12 (50%) of ≥20/20 (≥1.0). Mean central ECD decreased from 2867 (±161) cells/mm2 before to 1255 (±514) cells/mm2 at 1 month, 1058 (±455) cells/mm2 at 3 months and 968 (±427) cells/mm2 at 6 months after surgery. Rebubbling was performed in 4/12 eyes (33%) within the first two months.ConclusionsQuarter-DMEK may be a feasible procedure that allows for visual outcomes similar to conventional, circular DMEK. The relatively large drop in ECD within the first month may have resulted from more extensive endothelial cell migration and/or measurement error (at the graft edges). If longer-term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.

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Arnalich-Montiel, Francisco, Ane Pérez-Sarriegui et Alfonso Casado. « Impact of Introducing 2 Simple Technique Modifications on the Descemet Membrane Endothelial Keratoplasty Learning Curve ». European Journal of Ophthalmology 27, n^o 1 (13 mai 2016) : 16–20. http://dx.doi.org/10.5301/ejo.5000808.

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Purpose To analyze the impact of performing premarking of the Descemet roll and using SF6 20% on a surgeon's Descemet membrane endothelial keratoplasty (DMEK) learning process. Methods A total of 30 consecutive eyes with endothelial dysfunction undergoing DMEK during the learning curve of a surgeon were retrospectively analyzed. Prior to the study, the surgeon had already performed 10 DMEKs. The first 15 consecutive patients were included in group 1 (no premarking and air tamponade) and the other 15 consecutive patients were included in group 2 (premarking and SF6 tamponade). Main outcome parameters were best-corrected visual acuity (BCVA), endothelial cell density (ECD) loss at 6 months, and intraoperative and postoperative complications. Results Among the 2 groups, BCVA and ECD loss at 6 months were similar. However, there was a statistically significant reduction in primary graft failure (40% vs 0%) and need of rebubbling due to complete or partial graft detachment (40% vs 6%) when comparing group 1 versus group 2. In group 1, half of the patients needing rebubbling had primary graft failure. Conclusions Based on our personal experience, premarking the graft to assess orientation and using a SF6 gas tamponade dramatically reduces the risk of primary graft failure and the need for rebubbling even during the first stages of the learning curve. These findings should encourage surgeons to safely change from Descemet stripping automated endothelial keratoplasty to DMEK.

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Oganesyan, Oganes G., P. V. Makarov, A. A. Grdikanyan et V. R. Getadaryan. « THE TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM IN COMPLICATED CLINICAL SITUATIONS ». Medical Journal of the Russian Federation 24, n^o 3 (15 juin 2018) : 129–34. http://dx.doi.org/10.18821/0869-2106-2018-24-3-129-134.

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The transplantation of Descemet's membrane with endothelium (DMEK) is the most efficient method of treatment of endothelium pathology. However, it is considered that at certain clinical situations DMEK is inappropriate. The purpose of study is to analyze the results of DMEK in complicated clinical situations. Materials and methods. The sampling included 14 patients (16 eyes) with pathology of endothelium of primary (19%) and secondary (81%) genesis and with concomitant alterations, including: total lack of vitreous (19%), non-posterior chamber pseudophakia (25%), presence of Ahmed drainage (25%), artificial lensiris diaphragm (12%), corneal ectasia combined with toric artiphakia (12%), penetrating scar of cornea (6%). Prior to operation, average visual acuity amounted to 0,04±0,05. The subtotal DMEK was applied to 15 eyes and in one case ¼ DMEK was implemented. In 2 cases cornea of donor had keratotomic incisions and in one case Descemetotransplant was formed from residual back layers of cornea after formation of front layer wise transplant using femtosecond laser. The results. No intra-operational complications were established. In 19% of cases a partial mismatch of transplant took place. The repeated DMEK was implemented in 1 case. The recovery of transparency of cornea and increasing of vision acuity were achieved in 94% of cases. In 6 months after operation an average central thickness of cornea amounted to 522±46 μm and density of endothelium cells in average amounted to 1541±486 kl/mm2. Conclusion. The application of DMEK in complicated situations ensures high biological and functional results and is accompanied with minimal number of complications. The procurement of expertise in endothelium surgery, it is appropriate to apply DMEK in all cases of pathology of endothelium.

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Ní Dhubhghaill, Sorcha, Alina Miron, Jessica T. Lie, Isabel Dapena, Silke Oellerich et Gerrit R. J. Melles. « Preclinical testing of small diameter Descemet membrane endothelial keratoplasty grafts to increase tissue availability ». PLOS ONE 16, n^o 2 (4 février 2021) : e0246516. http://dx.doi.org/10.1371/journal.pone.0246516.

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In this study, we describe a process of preparing, surgically manipulating, and validating a novel “small diameter” 4mm circular Descemet membrane endothelial keratoplasty (DMEK) graft in vitro. Three small diameter DMEK grafts can be prepared from a single donor endothelium and could, therefore, potentially expand the donor pool. Prior to clinical use, however, we aimed to examine each step of the process to determine the effect on the endothelial cell loss and whether or not cells retained their capacity to migrate uniformly. For this study, circular small diameter grafts, obtained from twelve corneas of ten donors deemed ineligible for transplantation, were included. Small diameter DMEK graft preparation was successful in all cases (n = 36). Endothelial cell density (ECD), determined in the eye bank on seventeen grafts, showed an average decrease from 2413 (±189) cells/mm2 before to 2240 (±413) cells/mm2 after preparation. Twenty-four grafts were used to simulate DMEK-surgery in vitro and were successfully stained with 0.06% trypan blue, loaded into a straight DMEK-injector, unfolded, positioned, and centered within the circular ~ 4mm descemetorhexis. The estimated % area populated by viable cells on the grafts decreased from on average 92 (±3) % before to 78 (±10) % (n = 4) after in vitro surgery. Cells displayed a capacity for uniform cell migration from all edges of the graft (n = 4) when embedded in the 3D hydrogel system. Our data show, that by using an in vitro model of DMEK-surgery it was possible to test the 4mm circular DMEK grafts from eye bank preparation to surgical implantation. The cell loss after in vitro surgery was comparable with the in vivo ECD decline early after DMEK and the capacity of the cells to migrate to potentially cover bare stroma indicates that these small diameter grafts may be a viable clinical option to treat central endothelial disease.

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Parker, Jack, John S. Parker et Gerrit RJ Melles. « Descemet Membrane Endothelial Keratoplasty—A Review ». US Ophthalmic Review 06, n^o 01 (2013) : 29. http://dx.doi.org/10.17925/usor.2013.06.01.29.

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Descemet membrane endothelial keratoplasty (DMEK) is the most recent step forward in the evolution of endothelial keratoplasty toward thinner grafts and more natural, anatomic corneal restoration. Offering unprecedented visual results and requiring no special or expensive equipment, DMEK has the potential to become the first line treatment for corneal endothelial disorders. The surgery’s perceived shortcomings (primarily technical difficulty) have mostly been addressed by new ‘no-touch’ procedures for both graft preparation and graft unfolding in the recipient eye. And as a result, DMEK has been gaining traction with ophthalmologists the world over. Now, in its most recent formulation, DMEK is ready for the typical corneal surgeon, in any clinical setting, and at low cost.

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López, Ester Fernández, et Cristina Peris Martínez. « Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses ». Journal of Ophthalmology 2019 (27 octobre 2019) : 1–7. http://dx.doi.org/10.1155/2019/2038232.

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Purpose. To describe the surgical technique and clinical outcomes of bilensectomy (pIOL explant and phacoemulsification), followed by DMEK performed for bullous keratopathy secondary to pIOL. Methods. Seven eyes of seven patients, who developed corneal decompensation after pIOL implantation, underwent bilensectomy followed by DMEK in a two-step procedure. Main outcome measures included uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), refraction, endothelial cell density (ECD) at 1, 3, 6, and 12 months, and intraoperative and postoperative complications. Results. DMEK was performed at a mean time of 9.83 ± 8.23 months after bilensectomy. BCVA (log MAR) improved in all eyes, increasing from 1.11 ± 0.78 preoperatively to 0.54 ± 0.21, 0.28 ± 0.23, 0.21 ± 0.21, and 0.17 ± 0.17 at 1, 3, 6, and 12 months after DMEK. One year after surgery, mean spherical equivalent and cylinder were −0.70 ± 0.92 D and −1.50 ± 0.54 D, respectively. ECD decreased by 62 ± 4%, 69 ± 4%, 74 ± 4%, and 77 ± 3% at 1, 3, 6, and 12 months after DMEK. There was one case of primary graft failure and no other postoperative complications. Conclusions. The two-step technique bilensectomy followed by DMEK is a feasible technique for the management of bullous keratopathy secondary to pIOL, providing a fast visual recovery with good visual and refractive results.

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Luft, N., M. Dirisamer et S. Priglinger. « Descemet-Membran-Endothelkeratoplastik (DMEK) ». Klinische Monatsblätter für Augenheilkunde 234, n^o 03 (25 juillet 2016) : 354–64. http://dx.doi.org/10.1055/s-0042-105156.

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ZusammenfassungDie Descemet-Membran-Endothelkeratoplastik (DMEK) stellt den Goldstandard in der Therapie von isolierten Erkrankungen des Hornhautendothels dar, allen voran der Fuchs-Endotheldystrophie. Durch ihre überlegenen Visusergebnisse und aufgrund der niedrigeren und weiter sinkenden Komplikationsrate macht sie der weltweit etablierten Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) den Rang streitig. Die Etablierung einer standardisierten und reproduzierbaren DMEK-Methode und Fortschritte im Bereich der Spendergewebspräparation ebnen den Weg für viele Chirurgen, sich diese spannende und zugleich fordernde Operationstechnik anzueignen. Ein umfassender Blick in die Literatur zeigt, dass es gewisse verbleibende Herausforderungen der Methode zu adressieren gilt. Beispielsweise stellt die Transplantatablösung die häufigste Komplikation der DMEK dar. Es bedarf zukünftig großer prospektiv-randomisierter Studien, um die Vorteile der DMEK-Methode gegenüber alternativen lamellären Keratoplastiktechniken zu untermauern und verbleibende Problembereiche zu beleuchten.

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Saad, Alain, Emmanuel Guilbert, Alice Grise-Dulac, Patrick Sabatier et Damien Gatinel. « Intraoperative OCT-Assisted DMEK ». Cornea 34, n^o 7 (juillet 2015) : 802–7. http://dx.doi.org/10.1097/ico.0000000000000462.

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McKee, Hamish D., et Vishal Jhanji. « Learning DMEK From YouTube ». Cornea 36, n^o 12 (décembre 2017) : 1477–79. http://dx.doi.org/10.1097/ico.0000000000001399.

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Cursiefen, C., et F. E. Kruse. « DMEK : posteriore lamelläre Keratoplastiktechnik ». Der Ophthalmologe 107, n^o 4 (avril 2010) : 370–76. http://dx.doi.org/10.1007/s00347-010-2155-2.

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Lazaridis, Apostolos, Ourania Fydanaki, Eleftherios Giallouros, Ilias Georgalas, George Kymionis, Walter Sekundo et Konstantinos Droutsas. « Recovery of Corneal Clarity After DMEK Followed by Rebubbling Versus Uneventful DMEK ». Cornea 37, n^o 7 (juillet 2018) : 840–47. http://dx.doi.org/10.1097/ico.0000000000001554.

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Rickmann, Annekatrin, Silke Wahl, Nicola Hofmann, Arno Haus, Regina Michaelis, Tanja Petrich, Lutz Blomberg, Martin Börgel, Sascha Jung et Peter Szurman. « Precut DMEK Using Dextran-Containing Storage Medium Is Equivalent to Conventional DMEK ». Cornea 38, n^o 1 (janvier 2019) : 24–29. http://dx.doi.org/10.1097/ico.0000000000001778.

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Torras-Sanvicens, Josep, Irene Blanco-Domínguez, José-María Sánchez-González, Rahul Rachwani-Anil, Juan-Felipe Spencer, Noelia Sabater-Cruz, Jorge Peraza-Nieves et Carlos Rocha-de-Lossada. « Visual Quality and Subjective Satisfaction in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK) : A Fellow-Eye Comparison ». Journal of Clinical Medicine 10, n^o 3 (22 janvier 2021) : 419. http://dx.doi.org/10.3390/jcm10030419.

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Background: To analyze objective and subjective visual quality differences between descemet membrane endothelial keratoplasty (DMEK) and ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a paired contralateral-eye design. Methods: A cross-sectional, comparative, and observational case series study between DMEK and UT-DSAEK were presented. Visual acuity, refractive status and corneal quality assessment were compared between both endothelial keratoplasty techniques. The sample consisted of 20 eyes (10 patients) diagnosed with Fuchs endothelial corneal dystrophy. All measurements were performed preoperatively and at six months after surgery. Analyzed data included the measurement of objective scattering index, modulation transfer function, Strehl ratio, and optical quality assessment (OQAS) values. Contrast sensitivity, subjective patient satisfaction, visual acuity, tomography, pachymetry, endothelial cell count, and refraction status were also analyzed. Results: Objective and subjective visual quality variables had similar results among UT-DSAEK and DMEK procedures. Statistically significant differences favoring DMEK against UT-DSAEK were found in endothelial cell density (658.80 ± 139.33 and 1059.00 ± 421.84 cells/mm2, respectively), pachymetry (621.20 ± 33.74 and 529.70 ± 30.00 µm, respectively), and follow-up (45.50 ± 24.76 and 15.50 ± 8.43 months, respectively). Conclusions: UT-DSAEK and DMEK revealed no differences in terms of objective and subjective visual quality. However, DMEK showed a faster recovery during the follow-up, increased endothelial cell density, lower pachymetry, and a more anatomical posterior keratometry against UT-DSAEK in this case series paired-eye study.

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Satue, Maria, Miriam Idoipe, Alicia Gavin, Maria Romero-Sanz, Vasilios S. Liarakos, Antonio Mateo, Elena Garcia-Martin, Alejandro Blasco-Martinez et Antonio Sanchez-Perez. « Early Changes in Visual Quality and Corneal Structure after DMEK : Does DMEK Approach Optical Quality of a Healthy Cornea ? » Journal of Ophthalmology 2018 (23 septembre 2018) : 1–8. http://dx.doi.org/10.1155/2018/2012560.

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Purpose. To evaluate early changes in visual function and visual quality parameters after Descemet membrane endothelial keratoplasty (DMEK) and to compare the outcomes with healthy controls. Methods. Thirteen patients who underwent DMEK and 14 controls were evaluated. All subjects underwent visual function evaluation, including visual acuity under photopic and mesopic lighting conditions and contrast sensitivity (CSV) tests CSV 1000 and Pelli-Robson. Corneal parameters were assessed with Oculus Pentacam. Corneal mean keratometry (Km), corneal densitometry values, and low and high order aberrations (LOA and HOA) were recorded. In DMEK patients, all tests were performed before surgery and 1 and 6 months after surgery. Results. In patients who underwent DMEK, photopic visual acuity improved from 0.59 to 0.31 at 1 month (p=0.013) and 0.13 at 6 months (p=0.008); mesopic visual acuity and all contrast sensitivity values (both CSV and Pelli-Robson test) improved significantly in the first month (p<0.005). A significant decrease was observed in corneal density in the 0–2 mm ring (from 43.83 to 35.60, p=0.043) and mean posterior Km (from −5.84 to −6.80, p=0.005) in the first month. Corneal HOAs and all corneal densities improved at 6 months after DMEK (p<0.05). All visual function parameters and corneal aberrations remained lower and higher, respectively, compared with healthy controls (p<0.05). Corneal densities were comparable with controls at 6 months after DMEK (p>0.05). Conclusions. Patients undergoing DMEK present visual function improvement and a decrease in corneal density at 1 month after surgery. Decrease in corneal posterior HOAs can be observed at 6 months. However, visual function outcomes and corneal aberrations remained worse compared with healthy controls.

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Ang, Marcus, Adam M. Dubis et Mark R. Wilkins. « Descemet Membrane Endothelial Keratoplasty : Intraoperative and Postoperative Imaging Spectral-Domain Optical Coherence Tomography ». Case Reports in Ophthalmological Medicine 2015 (2015) : 1–4. http://dx.doi.org/10.1155/2015/506251.

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We describe a case report of using the same handheld spectral-domain anterior segment optical coherence tomography (ASOCT) for rapid intraoperative and postoperative imaging in a case of Descemet membrane endothelial keratoplasty (DMEK). A 67-year-old woman, with Fuchs dystrophy and corneal decompensation, underwent DMEK with intraoperative ASOCT imaging using the handheld Envisu spectral domain ASOCT system (Bioptigen, Inc., Morrisville, NC, USA). We found that this easy-to-use portable system with handheld probe allowed for rapid imaging of the anterior segment during donor manipulation to visualize the orientation of the DMEK donor, as well as to confirm the initial adhesion of the DMEK donor. Moreover, the same system may be used for postoperative monitoring of graft adhesion, corneal thickness, and stromal remodeling in the clinic with very high-definition images.

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Machalińska, Anna, Agnieszka Kuligowska, Bogna Kowalska et Krzysztof Safranow. « Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes ». Journal of Clinical Medicine 10, n^o 21 (30 octobre 2021) : 5119. http://dx.doi.org/10.3390/jcm10215119.

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Background: The need to provide a comparative analysis of corneal parameter changes compared to their preoperative values between Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) patients. Methods: The study included 24 eyes after UT-DSAEK and 24 eyes after DMEK. Visual acuity, endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA) and higher-order aberrations (HOAs) were assessed at baseline and 1, 3, 6 and 12 months after the surgery. Results: From the 3rd month post operation, ECC was higher in the DMEK eyes than in the UT-DSAEK eyes (p = 0.01). In a bivariate analysis that was adjusted for age, DMEK was associated with a smaller decrease in posterior MK at the 1-month (β = −0.49, p = 0.002), 3-month (β = −0.50, p < 0.001), 6-month (β = −0.58, p < 0.001) and 12-month (β = −0.49, p < 0.001) follow-up visits. There were no significant differences in changes in anterior or combined surface MK throughout the observation period. Accordingly, no significant differences in changes in MA, AA or HOAs compared to the baseline values were identified between the eyes after DMEK and UT-DSAEK at any follow-up time point. Conclusions: UT-DSAEK seemed to be an easier and safer technique than DMEK while maintaining similar outcomes regarding irregular astigmatism and total keratometry values.

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Agha, Bishr, Nura Ahmad, Daniel G. Dawson, Thomas Kohnen et Ingo Schmack. « Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy ». International Ophthalmology 41, n^o 8 (29 juin 2021) : 2897–904. http://dx.doi.org/10.1007/s10792-021-01850-w.

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Abstract Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

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Ruzza, Alessandro, Stefano Ferrari, Matteo Airaldi, Vito Romano et Diego Ponzin. « Effect of Low-Temperature Preservation in Optisol-GS on Preloaded, Endothelium-Out DMEK Grafts ». Journal of Clinical Medicine 12, n^o 3 (28 janvier 2023) : 1026. http://dx.doi.org/10.3390/jcm12031026.

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The aim of the study was to assess different temperature ranges for the preservation of pre-loaded Descemet Membrane Endothelial Keratoplasty (DMEK) grafts in the DMEK RAPID Mini device. Methods: Three groups of 15 DMEK grafts (five per group) were pre-loaded in the DMEK RAPID Mini and preserved in Optisol-GS for 72 h at different temperatures: group A at >8 °C, group B between 2–8 °C and group C at <2 °C. After stripping and preservation, the viability of the endothelium, cell loss and morphology were assessed through light microscopy following trypan blue and alizarin red staining. Results: Overall mortality was 4.07%, 3.97% and 7.66%, in groups A, B and C, respectively, with percentages of uncovered areas of 0.31%, 1.36% and 0.20% (all p > 0.05). Endothelial cell density variation was 5.51%, 3.06% and 2.82% in groups A, B and C, respectively (p = 0.19). Total Endothelial Cell Loss (ECL) was 4.37%, 5.32% and 7.84% in groups A, B and C, respectively (p = 0.39). Endothelial cell morphology was comparable in all three groups. Conclusions: In the DMEK RAPID Mini, low temperatures (<2 °C) may affect the quality of pre-loaded grafts, inducing a higher ECL after 72 h of preservation, although no significant differences among groups could be proved. Our data would suggest maintaining grafts loaded in the DMEK RAPID Mini at temperatures between 2–8 °C for appropriate preservation.

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Hayashi, Takahiko, Kentaro Yuda, Itaru Oyakawa et Naoko Kato. « Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty ». BioMed Research International 2017 (2017) : 1–5. http://dx.doi.org/10.1155/2017/9720389.

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Vital staining of the endothelial graft is essential during Descemet’s membrane endothelial keratoplasty (DMEK) to ensure surgical success. DMEK surgeons worldwide commonly use trypan blue (TB) to this end. However, TB may exert toxic effects on both the cornea and retina. Recently, Brilliant Blue G (BBG) has become recognized as an alternative stain for use during vitreoretinal surgery; BBG is associated with lower levels of toxicity. We retrospectively analyzed the utility of BBG staining during DMEK. We used 0.1% (w/v) BBG to stain the DMEK grafts of 12 patients. We evaluated the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) before and 3 and 6 months after surgery. BBG was effective in terms of graft visualization during DMEK. The BSCVA (log MAR) improved from0.99±0.57to0.01±0.07(p<0.05). The CCT decreased from720.3±58.1 μm preoperatively to511.5±50.6 μm at 6 months postoperatively (p=0.0001). The ECD decreased from2,754±296 cells/mm2to1,708±426 cells/mm2at 6 months postoperatively (p<0.001). The ECD loss was37.9±16.3%. The outcomes using BBG were comparable to those of earlier reports that employed TB; thus, BBG may be a viable alternative to TB.

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Alnawaiseh, Maged, Lars Zumhagen, André Rosentreter et Nicole Eter. « Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty ». Journal of Ophthalmology 2017 (2017) : 1–7. http://dx.doi.org/10.1155/2017/4068963.

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Purpose. To evaluate changes in anterior, posterior, and total corneal astigmatism in patients after Descemet membrane endothelial keratoplasty (DMEK). Methods. We retrospectively included 29 eyes of 23 patients (age 67.6 ± 9.8 years, 13 female, 10 male) after DMEK surgery. The magnitude and axis orientation of anterior, posterior, and total corneal astigmatism before and after DMEK were determined using a rotating Scheimpflug system (Pentacam HR, Oculus). Results. The magnitude of anterior, posterior, and total corneal astigmatism in the central cornea did not change significantly after surgery. Before surgery, we found a significant correlation between the magnitudes of anterior and posterior corneal astigmatism (Spearman’s correlation coefficient rS=0.526, P=0.003), while after surgery this correlation was no longer significant (rS=0.038, P=0.843). There was a significant correlation between the vector difference between preoperative and postoperative posterior astigmatism and the change in corneal pachymetry (rP=0.47, P=0.010). Conclusions. Posterior corneal astigmatism (especially the orientation) and therefore the relationship between anterior and total corneal astigmatism may change after DMEK. This should be considered to improve the accuracy of toric IOL power calculations following phakic DMEK or in combined procedures.

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Сердюк, В. Н., С. Б. Устименко, Е. В. Баландина et И. О. Коломиец. « Optimization of Descemet Membrane Endothelial Keratoplasty Using Intraoperative Optical Coherence Tomography ». Офтальмология. Восточная Европа, n^o 1 (4 mai 2020) : 60–64. http://dx.doi.org/10.34883/pi.2020.10.1.006.

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Введение. Эндотелиальная кератопластика десцеметовой оболочки (DMEK) является сложной процедурой для хирурга ввиду трудности визуального контроля прецизионности выполнения хирургических этапов. Интраоперационная оптическая когерентная томография (iOCT) при проведении DMEK является эффективным и перспективным методом, который позволяет хирургу лучше ориентироваться и контролировать процедуру, уменьшить количество интраоперационных осложнений, повлиять на скорость послеоперационной реабилитации пациентов. Цель. Повысить эффективность проведения эндотелиальной кератопластики десцеметовой оболочки (DMEK) с помощью точной визуализации хирургических этапов при помощи iOCТ. Методы. Проведено ретроспективное исследование 6 пациентов (6 глаз), посвященное изучению эффективности использования iOCT во время процедуры DMEK. Данная процедура проводилась пациентам с эндотелиальными дистрофиями, такими как эндотелиальная дистрофия Фукса (3 пациента 3 глаза), буллезная кератопатия (3 пациента 3 глаза). Все операции были проведены с использованием микроскопа Haag-Streit Hi-R NEO 900A NIR с установкой iOCT. Результаты. Правильная ориентация эндотелиального графта и его прилегание к строме реципиента были подтверждены при помощи iOCT в 6/6 случаев. В первый послеоперационный день прилегание DМ донорского материала к строме реципиента наблюдалось в 5/6 случаев. В одном случае была отмечена видимая периферическая дегисценция графта, которая была нивелирована введением 10 газовой смеси S3F8. Заключение. iOCT позволяет в разы повысить прецизионность выполнения основных этапов процедуры DMEK, особенно при визуальном контроле ориентации трансплантата, оценке прилегания графта к строме реципиента, наличия жидкости в интерфейсе трансплантат донор, тем самым снижается длительность послеоперационной реабилитации, минимизируются риски осложнений и улучшается качество зрения. Introduction. Descemet membrane endothelial keratoplasty (DMEK) is a complex procedure for the surgeon due to the difficulty of visual monitoring the precision of the surgical stages. iOCT during DMEK is an effective and promising method that allows the surgeon to navigate and control the procedure better, reduce the number of intraoperative complications, and affect the speed of postoperative rehabilitation of patients. Purpose. To improve the efficiency of Descemet Membrane Endothelial Keratoplasty (DMEK) using Intraoperative Optical Coherence Tomography (iOCT) and femtosecond laser system. Materials and methods. Retrospective analysis of 6 cases (6 eyes) of planned DMEK using on patients with endothelial dystrophy (such as Fuchs endothelial dystrophy 3 patients 3 eyes), bullous keratopathy (3 patients 3 eyes). All operations were performed using Haag-Streit Hi-R NEO 900A NIR microscope with iOCT. Results and discussion. The correct orientation of the endothelial graft and its attachment to the recipient stroma were confirmed by iOCT in 6/6 cases. On the first postoperative day, the adherence of the DM donor to the recipient stroma was observed in 5/6 cases. In one case, a visible peripheral graft dehiscence and it was fixed by 10 S3F8 gas mixture introducing. Conclusions. iOCT can significantly increase the precision of the main stages of the DMEK procedure, especially: monitoring of the transplant orientation, assessing the grafts adherence to the recipients stroma, and the presence of fluid in the graft donor interface, thereby reducing duration of postoperative rehabilitation, minimizing the risk of complications and improving the quality of vision.

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Alió del Barrio, Jorge L., Alfredo Vega-Estrada et Jorge L. Alió. « Descemet Membrane Endothelial Keratoplasty (DMEK) Under Previous DMEK for Secondary Endothelial Graft Failure ». Cornea 37, n^o 6 (juin 2018) : 793–95. http://dx.doi.org/10.1097/ico.0000000000001543.

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Singh, Tanu, Parul Ichhpujani, Rohan Bir Singh, Sudesh Arya et Suresh Kumar. « Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty ? A systematic review and meta-analysis ». Therapeutic Advances in Ophthalmology 15 (janvier 2023) : 251584142211478. http://dx.doi.org/10.1177/25158414221147823.

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Background: Ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) is a recently developed surgical procedure that has shown promising results for the management of various corneal endothelial diseases. Objectives: To evaluate the outcomes of the UT-DSAEK to the Descemet membrane endothelial keratoplasty (DMEK). Design: A systematic analysis of the studies comparing UT-DSAEK with DMEK by evaluating one or more outcomes (vision, complications, and post-operative endothelial cell counts) was performed. The meta-analysis was done if two or more studies reported a common outcome. Methods: We used PubMed, EMBASE, and SCOPUS databases to identify articles comparing the outcomes of UT-DSAEK with DMEK and performed a meta-analysis using RevMan, version 5.4. Results: A total of six studies were included in this review (two randomized clinical trials and four non-randomized comparative studies). Our analysis showed the patients who underwent DMEK cases showed better visual outcomes with a mean difference of 0.06 LogMAR (95% CI: 0.04–0.09) in BCVA, albeit with i2 of 52% (heterogenous values). The evidence was weak, with the most weightage on retrospective studies. UT-DSAEK showed significantly fewer complications such as graft dislocations, with an odds ratio of 0.25 (95% CI: 0.13–0.48). There was no significant difference in the endothelial cell counts with a mean difference of 86.34 (95%CI: –133.09 to –305.77). Conclusion: Although the literature is limited on UT-DSAEK with post-operative visual acuity that could be practically at par with DMEK, lesser complication rates and comparable post-operative endothelial cells could be a suitable alternative to DMEK for corneal endothelial pathologies.

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Yamada, Norihiro, Takahiko Hayashi, Kentaro Yuda, Toshiki Shimizu, Itaru Oyakawa, Hidenori Takahashi et Naoko Kato. « Outcomes of Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes with Sutured Posterior Chamber Intraocular Lens ». Journal of Ophthalmology 2018 (2018) : 1–7. http://dx.doi.org/10.1155/2018/3127126.

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Purpose. To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) for vitrectomized eyes that underwent pars plana vitrectomy (PPV) and transscleral-sutured intraocular lens (IOL) implantation. Methods. In this retrospective study, DMEK cases were reviewed from medical records and divided into two groups: the eyes after PPV and transscleral-sutured IOL implantation (vitrectomized group) and the eyes with in-the-bag IOL implantation (control group) prior to DMEK. The main outcome measures included time of graft unfolding during surgery and best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, and 6 months after the DMEK. Results. Twenty-three eyes (vitrectomized group, n=8; control group, n=15) in 23 patients were included in this study. The unfolding time was significantly longer in the vitrectomized group than in the control group (P<0.001). Postoperative BSCVA was worse in the vitrectomized group (0.16 ± 0.15) than in the control group (−0.06 ± 0.06; P=0.017). The improvement in BSCVA was negatively correlated with the patients’ age and frequency of previous surgeries. Conclusions. Despite the longer graft unfolding time and limited visual recovery, DMEK should be applicable to vitrectomized eyes with transscleral-sutured IOL implantation.

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Thompson, Matthew, et David Carli. « First Reported Case of Donor Related Candida Endophthalmitis after Descemet Membrane Endothelial Keratoplasty ». Open Ophthalmology Journal 11, n^o 1 (19 juin 2017) : 117–21. http://dx.doi.org/10.2174/1874364101711010117.

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Purpose: To report the first case of Candida donor to host transmission following descemet membrane endothelial keratoplasty (DMEK) Methods: A retrospective case report. Results: A patient underwent uneventful DMEK. Following surgery the donor rim was culture positive for Candida. The patient developed fungal endophthalmitis that was treated medically with multiple injections of voriconazole and amphotericin. Medical treatment was unable to clear the infection and removal of the donor material was required. Following removal the infection subsided. Conclusion: Candida interface keratitis and endophthalmitis can occur following DMEK and may be difficult to treat medically. Early removal of the donor material should be considered.

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Sudana, Priyanka, Sunita Chaurasia, Joveeta Joseph et Dilip Kumar Mishra. « Delayed postoperative interface keratitis due to Enterococcus faecalis after Descemet membrane endothelial keratoplasty ». BMJ Case Reports 14, n^o 1 (janvier 2021) : e238389. http://dx.doi.org/10.1136/bcr-2020-238389.

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To report the clinical course and management of interface keratitis due to Enterococcus faecalis after Descemet membrane endothelial keratoplasty (DMEK). A 64-year-old man underwent DMEK, with unevenful immediate postoperative course, with a visual recovery of 20/30 at 2 weeks. At 3 months of clinical visit, interface keratitis was noted. DMEK graft removal with stromal bed scrapings was performed. A diagnosis of E. faecalis interface keratitis was made. The patient responded favourably to antibiotic susceptibility-guided intensive treatment with vancomycin 5% with complete resolution of infection. After 2 months of graft removal, Descemet stripping endothelial keratoplasty (DSEK) was performed. The corneal clarity was restored and the best corrected visual acuity was 20/40 at last follow-up of 1 year. E. faecalis should be kept as a differential in delayed onset interface keratitis after DMEK. After microbiological cure with antibiotic therapy, visual rehabilitation with DSEK restores corneal clarity and results in favourable visual outcome.

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Ashena, Zahra, Thomas Hickman-Casey et Mayank A. Nanavaty. « Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty ». Therapeutic Advances in Ophthalmology 13 (janvier 2021) : 251584142110277. http://dx.doi.org/10.1177/25158414211027705.

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A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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Chaussard, Dimitri, Florian Bloch, Arpiné Ardzivian Elnar, Yinka Zevering, Jean-Charles Vermion, Rémi Moskwa et Jean-Marc Perone. « Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty : A retrospective cohort study ». PLOS ONE 17, n^o 2 (24 février 2022) : e0264401. http://dx.doi.org/10.1371/journal.pone.0264401.

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Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015–2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding.

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Zeidenweber, Dorian A., Khoa D. Tran, Christopher S. Sales, Stephen W. Wehrer, Michael D. Straiko et Mark A. Terry. « Prestained and Preloaded DMEK Grafts ». Cornea 36, n^o 11 (novembre 2017) : 1402–7. http://dx.doi.org/10.1097/ico.0000000000001329.

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Bachmann, Björn, Silvia Schrittenlocher, Friederike Schaub, Sebastian Siebelmann, Mario Matthaei et Claus Cursiefen. « DMEK : Probleme vermeiden, erkennen, lösen ». Klinische Monatsblätter für Augenheilkunde 234, n^o 11 (31 juillet 2017) : 1354–61. http://dx.doi.org/10.1055/s-0043-105269.

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ZusammenfassungSeit der ersten erfolgreichen Descemet Membrane endothelial Keratoplasty (DMEK) vor über 10 Jahren hat sich diese Technik in vielen Regionen zu einem Routineeingriff entwickelt, der mittlerweile einen festen Platz im ophthalmochirurgischen Armamentarium bei der Behandlung von Hornhautendothelerkrankungen einnimmt. Im Vergleich mit der etwas älteren Methode der Descemetʼs Stripping (automated) endothelial Keratoplasty (DS[A]EK), bei der das Transplantat im Gegensatz zur DMEK noch eine Stromalamelle besitzt, wird bei der DMEK eine schnellere und bessere Visuserholung erzielt und gleichzeitig ist das Risiko der Abstoßungsreaktion deutlich reduziert. Dennoch birgt die Technik einige Schwierigkeiten, die ein besonderes Vorgehen zur Vermeidung intra- und postoperativer Komplikationen notwendig machen. Hierzu zählen Strategien zur Vermeidung von Endothelschädigungen während der Präparation, die richtige Spender-Patienten-Allokation ist wichtig für eine schonende Entfaltung der Transplantatrolle in der Vorderkammer, die Verwendung von SF6-Gas zur Transplantatanlage vermindert die Transplantatablösungsrate und damit die Notwendigkeit erneuter Vorderkammertamponaden (Rebubblings), und die richtige postoperative Behandlung mit topischen Steroiden hat maßgeblichen Einfluss auf die Entwicklung von zystoidem Makulaödem und Abstoßungsreaktionen. Durch die weitere Standardisierung, aber auch Individualisierung der DMEK kann sie mittlerweile auch bei Patienten mit schwierigen anatomischen Voraussetzungen des vorderen Augenabschnitts (anteriore Synechien, größere Irisdefekte, Glaukomdrainageimplantate) regelmäßig durchgeführt werden, wodurch gerade solche Patienten mit tendenziell erhöhtem Risiko von Wundheilungsstörungen und Abstoßungsreaktionen im Übermaß profitieren.

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Melles, Gerrit R. J., T. San Ong, Bob Ververs et Jacqueline van der Wees. « Descemet Membrane Endothelial Keratoplasty (DMEK) ». Cornea 25, n^o 8 (septembre 2006) : 987–90. http://dx.doi.org/10.1097/01.ico.0000248385.16896.34.

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Altinors, Dilek Dursun, Leyla Asena, Gursel Yilmaz et Sibel Oto. « Descemetʼs Membrane Endothelial Keratoplasty (DMEK) ». Transplantation 102 (juillet 2018) : S823. http://dx.doi.org/10.1097/01.tp.0000543868.12525.d9.

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MELLES, GRJ, TS ONG, B. VERVERS et J. VAN DER WEES. « DLEK to DSEK to DMEK ». Acta Ophthalmologica Scandinavica 85 (2 octobre 2007) : 0. http://dx.doi.org/10.1111/j.1600-0420.2007.01063_2870.x.

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Katamish, T. « Descemets membrane endothelial keratoplasty (DMEK) ». Acta Ophthalmologica 93 (23 septembre 2015) : n/a. http://dx.doi.org/10.1111/j.1755-3768.2015.0241.

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Ciechanowski, P. P., K. Droutsas, L. Baydoun, M. Dirisamer, S. Oellerich et G. R. J. Melles. « Standardisierte Descemet-Membran-Endothelkeratoplastik (DMEK) ». Der Ophthalmologe 111, n^o 11 (26 avril 2014) : 1041–49. http://dx.doi.org/10.1007/s00347-013-3014-8.

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Livny, Eitan, Irit Bahar, Issac Levy, Michael Mimouni et Yoav Nahum. « “PI-less DMEK” : results of Descemet’s membrane endothelial keratoplasty (DMEK) without a peripheral iridotomy ». Eye 33, n^o 4 (5 décembre 2018) : 653–58. http://dx.doi.org/10.1038/s41433-018-0294-x.

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Abicca, Irene, Marta Gilardi, Daniela Giannini, Rossella Anna Maria Colabelli Gisoldi, Augusto Pocobelli et Domenico Schiano Lomoriello. « Corneal Subbasal Plexus in Eyes with Fuchs’ Endothelial Corneal Dystrophy after Two Different Endothelial Surgeries ». Journal of Ophthalmology 2021 (4 octobre 2021) : 1–6. http://dx.doi.org/10.1155/2021/5098272.

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Purpose. To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs’ endothelial corneal dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods. We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results. Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant ( P = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson’ chi-square, 0.755). Conclusions. Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.

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