Assessment of Eye Bank–Prepared Posterior Lamellar Corneal Tissue for Endothelial Keratoplasty (original) (raw)
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Medicine, 2017
The purpose of this article is to examine outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed with cornea bank (CB) prestripped tissue and surgeon stripped tissue (SST). This retrospective study examined subjects who underwent DMEK with CB or surgeon prepared tissue for Fuchs endothelial corneal dystrophy. Best-corrected visual acuity (BCVA), corneal thickness, endothelial cell count (ECC), and complications were examined before and throughout a 6-month postoperative period. Eleven CB and 22 SST subjects were included. Six months after surgery, BCVA was 20/20 or better in 36.4% of CB and 22.7% of SST subjects (P = .43). Median logMAR BCVA was 0.10 (0.00-0.20, 20/25) in group CB and 0.10 (0.10-0.30, 20/25) in group SST. Median preoperative corneal thickness was 614.0 mm (577.5-662.0 mm) and 658.0 mm (606.0-689.0 mm) in CB and SST subjects, respectively (P = .37). Six months after surgery, median corneal thickness was lower in the CB group (571.0 mm [478.0-592.0 mm]), than in the SST group (576.0 mm [531.0-607.0 mm], P = .02). At 6 months, median ECC was 1500.0 cell/mm 2 (1321.5-2049.0 cell/ mm 2 , 41% decrease) in group CB and 1403.0 cell/mm 2 (972.5-2010.7 cell/mm 2 , 46% decrease) in group SST (P = .70). Rebubbling was required in 5 CB (45.5%) and 15 SST (68.2%) subjects (P = .39). Fuchs' dystrophy patients have good anatomic and functional DMEK results. Similar outcomes and complication rates occurred with eye bank and surgeon prepared donor tissue. Abbreviations: ANSM = Agence nationale de sécurité du médicament et des produits de santé, BCVA = best corrected visual acuity, BSS = buffered saline solution, CB = cornea bank, CCT= central corneal thickness, DM = Descemet membrane, DMEK = Descemet Membrane Endothelial Keratoplasty, DSEK = Descemet Stripping Endothelial Keratoplasty, ECC = endothelial cell count, ECD = endothelial cell density, FECD = Fuchs endothelial corneal dystrophy, HCEnC = human corneal endothelial cell, logMAR = logarithm of the minimum angle of resolution, OR = operating room, SD = standard deviation, SST = surgeon strip tissue.
Cornea, 2008
To assess surgeon satisfaction with precut corneal tissue from 1 eye bank for Descemet stripping automated endothelial keratoplasty (DSAEK). Surgical techniques and predictors of procedural success were also examined. A 19-question survey was completed by 53 surgeons around the United States for 197 DSAEK cases using prepared corneal allograft tissue from the Iowa Lions Eye Bank. Surgeries were performed between April 1 and December 31, 2006; surveys were completed retrospectively within a few weeks of surgery. Tissue was found to be acceptable in 98% of DSAEK cases reported. Difficulties with precut tissue (eg, lack of anterior cap adherence to the posterior lamella, not visible or decentered central dot, anterior edge undermining) were reported in approximately 10% of cases. A rebubbling procedure was performed in 23% of cases for donor dislocations. The donor lenticule adhered, with resulting corneal deturgescence, in 86% of cases. Surgeons declared a successful procedure in 92% ...
Eye-bank preparation of endothelial tissue
Current Opinion in Ophthalmology, 2014
Purpose of review-Eyebank preparation of endothelial tissue for keratoplasty continues to evolve. While eye bank personnel have become comfortable and competent at Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) tissue preparation and tissue transport, optimization of preparation methods continues. Surgeons and eye bank personnel should be up to date on the research in the field. As surgeons transition to Descemet Membrane Endothelial Keratoplasty (DMEK), eye banks have risen to the challenge of preparing tissue. Eye banks are refining their DMEK preparation and transport techniques Recent findings-This article covers refinements to DSAEK tissue preparation, innovations to prepare DMEK tissue, and nuances to improve donor cornea tissue quality. Summary-As eye bank supplied corneal tissue is the main source of tissue for many corneal surgeons, it is critical to stay informed about tissue handling and preparation. Ultimately the surgeon is responsible for the transplantation, so involvement of clinicians in eye banking practices and advocacy for pursuing meaningful research in this area will benefit clinical patient outcomes.
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Journal of Visualized Experiments, 2014
Over the past ten years, corneal transplantation surgical techniques have undergone revolutionary changes 1,2 . Since its inception, traditional full thickness corneal transplantation has been the treatment to restore sight in those limited by corneal disease. Some disadvantages to this approach include a high degree of post-operative astigmatism, lack of predictable refractive outcome, and disturbance to the ocular surface. The development of Descemet's stripping endothelial keratoplasty (DSEK), transplanting only the posterior corneal stroma, Descemet's membrane, and endothelium, has dramatically changed treatment of corneal endothelial disease. DSEK is performed through a smaller incision; this technique avoids 'open sky' surgery with its risk of hemorrhage or expulsion, decreases the incidence of postoperative wound dehiscence, reduces unpredictable refractive outcomes, and may decrease the rate of transplant rejection 3-6
Descemet Membrane Endothelial Keratoplasty (DMEK) selectively replaces the damaged posterior part of the cornea. However, the DMEK technique relies on a manually-performed dissection that is timeconsuming, requires training and presents a potential risk of endothelial graft damages leading to surgery postponement when performed by surgeons in the operative room. To validate precut corneal tissue preparation for DMEK provided by a cornea bank in order to supply a quality and security precut endothelial tissue. The protocol was a technology transfer from the Netherlands Institute for Innovative Ocular Surgery (NIIOS) to Lyon Cornea Bank, after formation in NIIOS to the DMEK ''no touch'' dissection technique. The technique has been validated in selected conditions (materials, microscope) and after a learning curve, cornea bank technicians prepared endothelial tissue for DMEK. Endothelial cells densities (ECD) were evaluated before and after preparation, after storage and transport to the surgery room. Microbiological and histological controls have been done. Twenty corneas were manually dissected; 18 without tears. Nineteen endothelial grafts formed a double roll. The ECD loss after cutting was 3.3 % (n = 19). After transportation 7 days later, we found an ECD loss of 25 % (n = 12). Three days after cutting and transportation, we found 2.1 % of ECD loss (n = 7). Histology found an endothelial cells monolayer lying on Descemet membrane. The mean thickness was 12 ± 2.2 lm (n = 4). No microbial contamination was found (n = 19). Endothelial roll stability has been validated at 3 days in our cornea bank. Cornea bank technicians trained can deliver to surgeons an ECD controlled, safety and ready to use endothelial tissue, for DMEK by ''no touch'' technique, allowing time saving, quality and security for surgeons.