Outcomes of contact lens-assisted pull-through technique for delivery of tri-folded (endothelium in) DMEK grafts

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 08:40

Venue: Hall C1

First Author: : P.Leon ITALY

Co Author(s): :    S. Gutfreund   S. Graffi   G. Giannaccare   L. Mattioli   M. Busin        

Abstract Details

Purpose:

To evaluate the outcomes of contact lens-assisted bimanual pull-through delivery of Descemet membrane endothelial keratoplasty (DMEK) tissue trifolded with the endothelium inward.

Setting:

Villa Igea Private Hospital Forlì Italy

Methods:

Standardized DMEK was performed as a single procedure (n=25) or in combination with phacoemulsification and implantation of a posterior chamber intraocular lens (n=62) using prestripped donor tissue punched to a diameter of 8.25mm and then trifolded with the endothelium in. Using a sterile soft contact lens as scaffold, the tissue was loaded in this configuration into a disposable cartridge and delivered into the anterior chamber under continuous irrigation using a bimanual pull-through technique. Intraoperative and postoperative complications, best corrected visual acuity (BCVA) and endothelial cell density after surgery were recorded.

Results:

Eighty-seven eyes of 87 patients were included. Indications for DMEK were Fuchs dystrophy (n=65), Pseudophakic bullous keratopathy (n=15) and previous failed endothelial graft (n=7). Mean follow-up time was 14.5±3.7 (range 12-24)months. In eyes with a postoperative follow-up of 6 months (n=41),83% of patients achieved BCVAof 20/25 or better, 59%achieved BCVA of 20/20 or better and 22% achieved BCVA of 20/15 or better. Mean postoperative endothelial cell count was 1982±314cells/mm2 (range 1060-2660 cells/mm2) resulting in acell loss of 22.4±12.2%(range 2.3%-62.1%).Graft detachment rate was 27.6%, successfully managed in all cases by a single rebubbling procedure.

Conclusions:

Delivering DMEK tissue, trifolded with the endothelium inward, reduces surgical trauma to donor cells and facilitates spontaneous unfolding, thus minimizing surgical time.

Financial Disclosure:

... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented