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Double-Glide Method Using Cathereep Protective Sheet As a Substitute in Descemet's Stripping Automated Endothelial Keratoplasty  [PDF]
Hiroshi Toshida,Rio Honda,Asaki Matsui,Yusuke Matsuzaki,Yusuke Shimizu,Takahiko Seto,Toshihiko Ohta,Akira Murakami
ISRN Transplantation , 2013, DOI: 10.5402/2013/713153
Abstract: Purpose. For the insertion of the donor graft in Descemet's stripping automated endothelial keratoplasty (DSAEK), the double-glide method using a Busin glide and intraocular lens (IOL) glide concomitantly has been shown to be effective. The aim of this report is to evaluate the results for the double-glide method using Cathereep (Nichiban, Tokyo, Japan), a protective sheet made of polyurethane film for medical use, as a substitute for an IOL glide. Materials and Methods. The subjects were 10 eyes of 10 patients with bullous keratopathy. The DSAEK operation was performed, and the double-glide method was used for the donor graft insertion. During the operation, an IOL glide was used for the 5 eyes, and the Cathereep protection sheet was used for the remaining 5 eyes. We trimmed approximately 5?mm wide strips from the nonadhesive area surrounding the Cathereep protection sheet. Results. The donor graft was inserted equally easily with the Cathereep protective sheet and IOL glides and improvement of visual acuity was noted in both groups significantly. A favorable postoperative course was obtained with no perioperative complications including endothelial damage. Conclusions. Cathereep protective sheet can be used as a substitute for an IOL glide for double-glide method in DSAEK. 1. Introduction The operative procedure of keratoplasty has progressed rapidly since the end of the twenty century, and implantations for lesions on a layer-by-layer basis are gradually becoming popular. High among the most popular methods of treating bullous keratopathy over the last decade is Descemet’s stripping automated endothelial keratoplasty (DSAEK) [1–4]. The safety and reliability of the DSAEK procedure is founded upon experimentation with measures designed to minimize the damage to corneal endothelial cells at the time of drawing donor cells into the anterior chamber. One method for the insertion of donor graft is a double-glide method using a Busin glide [5] and an intraocular lens (IOL) glide concomitantly for drawing the donor graft. The usefulness of this method has been reported by Kobayashi et al., and the procedure is increasingly popular [6]. The IOL glide (Alcon Laboratories, Fort Worth, TX, USA) is used to prevent damage to corneal endothelial cells due to direct contact of the donor cells with the iris. Unfortunately, however, the IOL glides are no longer in production, which may interfere with future operations. We found favorable results obtained in the double-glide method using Cathereep (Nichiban Co. Ltd, Tokyo, Japan) protective sheet made of polyurethane
Descemet's stripping automated endothelial keratoplasty for congenital hereditary endothelial dystrophy
Anwar HM, El Danasoury AM, Hashem AN
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S28405
Abstract: cemet's stripping automated endothelial keratoplasty for congenital hereditary endothelial dystrophy Case report (2715) Total Article Views Authors: Anwar HM, El Danasoury AM, Hashem AN Published Date January 2012 Volume 2012:6 Pages 159 - 163 DOI: http://dx.doi.org/10.2147/OPTH.S28405 Received: 20 November 2011 Accepted: 12 December 2011 Published: 24 January 2012 Hamed M Anwar, AM El Danasoury, AN Hashem Corneal and Refractive Surgery Unit, Magrabi Eye Hospital, Jeddah, Saudi Arabia Abstract: Congenital hereditary endothelial dystrophy (CHED), presents in infancy or early childhood with bilateral clouding of corneas. This condition has previously been managed surgically with penetrating keratoplasty (PKP). Performing PKP in pediatric patients has its own set of difficulties. More recently, there has been growing interest in treating this condition with Descemet's stripping automated endothelial keratoplasty (DSAEK). The purpose of this study is to report our experience of successfully performing DSAEK in a child with CHED.
Histopathological Findings after Descemet's Stripping Automated Endothelial Keratoplasty for the Management of Descemet's Membrane Breaks Secondary to Obstetrical Forceps Injury
Luis J. Haddock,Sander R. Dubovy,Victor L. Perez
Case Reports in Ophthalmological Medicine , 2012, DOI: 10.1155/2012/474795
Abstract: Case of a 39 y/o male patient that presented due to decreased vision and pain in the left eye secondary to corneal edema related to vertical Descemet's membrane breaks. The patient's past medical history was remarkable for a complicated vaginal delivery with the use of obstetrical forceps and presumed obstetrical forceps corneal injury. Herein, we demonstrate for the first time the use of descemet's stripping automated endothelial keratoplasty (DSAEK) in the management of this complication and for the first time show histologically the area of prior descemet's membrane break in the submitted stripped descemet's membrane.
Descemet Stripping Endothelial Keratoplasty in a Patient with Keratoglobus and Chronic Hydrops Secondary to a Spontaneous Descemet Membrane Tear  [PDF]
Anton M. Kolomeyer,David S. Chu
Case Reports in Ophthalmological Medicine , 2013, DOI: 10.1155/2013/697403
Abstract: Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient with keratoglobus and chronic hydrops. Case Report. We describe a case of a 28-year-old man with bilateral keratoglobus and chronic hydrops in the right eye secondary to spontaneous Descemet membrane tear. The patient presented with finger counting (CF) vision, itching, foreign body sensation, and severe photophobia in the right eye. Peripheral corneal thinning with central corneal protrusion and Descemet membrane tear spanning from 4 to 7 o'clock was noted on slit lamp examination. The right eye cornea was 15?mm in the horizontal diameter. After a 5.5-month loss to follow-up, the patient presented with discomfort, photophobia, decreasing vision, and tearing in the right eye. Vision was 20/60 with pinhole. 360-degree peripheral corneal ectasia with mild neovascularization and hydrops was present. Over the next few months, the patient complained of photophobia and intermittent eye pain. His vision deteriorated to CF, he developed corneal scarring with bullae, and a DSEK was performed. Eight months postoperatively, best-corrected vision improved to 20/30, cornea was clear, and the DSEK graft was stable. Conclusions. Nonresolving hydrops secondary to Descemet membrane tear in a patient with keratoglobus may result in permanent endothelial cell damage and scar formation. This may be successfully treated with DSEK. 1. Introduction Keratoglobus is an idiopathic disorder with 360-degree peripheral corneal ectasia resulting in central corneal protrusion [1]. It is associated with ocular conditions such as orbital pseudotumor, vernal keratoconjunctivitis, chronic marginal blepharitis, and glaucoma after penetrating keratoplasty surgery; congenital conditions including Leber congenital amaurosis and blue sclera syndrome; and several connective tissue disorders, for example, Ehlers-Danlos syndrome, Marfan syndrome, and Rubinstein-Taybi syndrome [2–6]. Visual impairment in patients with keratoglobus can be profound, and may occur secondarily to corneal scarring and rupture (due to severe corneal ectasia), irregular astigmatism, and extreme myopia. Hydrops develops due to breaks in the Descemet membrane followed by aqueous infiltration of the stroma and the epithelium in up to 91% of keratoglobus eyes, and can result in corneal scar formation in severe cases [7]. Other reported serious side effects include corneal perforation, microbial keratitis, and glaucoma [8, 9]. Factors predisposing to the development of hydrops include younger age, male gender, advanced corneal
Descemet's stripping automated endothelial keratoplasty for congenital hereditary endothelial dystrophy  [cached]
Anwar HM,El Danasoury AM,Hashem AN
Clinical Ophthalmology , 2012,
Abstract: Hamed M Anwar, AM El Danasoury, AN HashemCorneal and Refractive Surgery Unit, Magrabi Eye Hospital, Jeddah, Saudi ArabiaAbstract: Congenital hereditary endothelial dystrophy (CHED), presents in infancy or early childhood with bilateral clouding of corneas. This condition has previously been managed surgically with penetrating keratoplasty (PKP). Performing PKP in pediatric patients has its own set of difficulties. More recently, there has been growing interest in treating this condition with Descemet's stripping automated endothelial keratoplasty (DSAEK). The purpose of this study is to report our experience of successfully performing DSAEK in a child with CHED.Keywords: congenital hereditary endothelial dystrophy, CHED, DSAEK, Descemet's stripping automated endothelial keratoplasty
Histopathological Findings after Descemet's Stripping Automated Endothelial Keratoplasty for the Management of Descemet's Membrane Breaks Secondary to Obstetrical Forceps Injury  [PDF]
Luis J. Haddock,Sander R. Dubovy,Victor L. Perez
Case Reports in Ophthalmological Medicine , 2012, DOI: 10.1155/2012/474795
Abstract: Case of a 39?y/o male patient that presented due to decreased vision and pain in the left eye secondary to corneal edema related to vertical Descemet's membrane breaks. The patient's past medical history was remarkable for a complicated vaginal delivery with the use of obstetrical forceps and presumed obstetrical forceps corneal injury. Herein, we demonstrate for the first time the use of descemet's stripping automated endothelial keratoplasty (DSAEK) in the management of this complication and for the first time show histologically the area of prior descemet's membrane break in the submitted stripped descemet's membrane. 1. Introduction Descemet’s membrane breaks occur secondary to a variety of conditions that include congenital glaucoma, keratoconus, and trauma. These breaks are classified depending on their time of presentation in early childhood or adulthood, laterality, affecting one or both eyes, and corneal orientation, as vertical, horizontal, or oblique. Descemet’s breaks can be seen in newborns after complicated forceps delivery because Descemet’s membrane is thin and susceptible to stretching at birth [1]. The vertical breaks result from a horizontal stretching of the globe that occurs with vertical compression of the eye between the orbital roof and the blade of the obstetric forceps [2]. These patients can present with decreased vision early in life, secondary to corneal opacification, induced astigmatism, and/or amblyopia, or in adulthood secondary to corneal edema resulting from gradual endothelial decompensation of a previously compromised endothelium [3]. Here we report the clinical history and histopathological correlation of the findings in the stripped Descemet's membrane of a patient who underwent Descemet's stripping endothelial keratoplasty to correct a cornea that failed because of vertical Descemet's breaks associated to forceps injury during delivery. 2. Case Report A 39?y/o male patient presented with a 2-month history of decreased vision, halos, pain, and photophobia of the left eye. The patient was diagnosed with keratoconus at age 16, for which he used rigid contact lens in the left eye, with a best corrected visual acuity (VA) of 20/60. The patient’s past medical history revealed that he had a complicated vaginal delivery with the use of obstetrical forceps. Clinical examination showed a VA of 20/400 in the left eye with a refraction of and a stable VA of 20/20 in the right eye with a refraction of . Slit lamp biomicroscopy displayed corneal stromal and epithelial edema associated with centrally located parallel vertical
Descemet’s Stripping-Automated Endothelial Keratoplasty for Traumatic Aniridia and Aphakia
Sabah S. Jastaneiah
Case Reports in Ophthalmological Medicine , 2012, DOI: 10.1155/2012/982657
Abstract: This Interventional case reports a challenging case of descemet’s stripping-automated endothelial keratoplasty (DSAEK) in a young male patient with traumatic aniridia, aphakia, and corneal edema. Surgery was planned in two stages; first was implantation of aniridia intraocular lens (AIOL), few months later, DSAEK procedure was performed. Successful outcome of both procedures was achieved as measured by the stability of the AIOL, clarity of the cornea, attachment of the lenticule, and improvement in vision. Aniridia implant supports a sufficient amount of air in the anterior chamber especially if the posterior segment is well formed, while providing the required lens power to improve vision. DSAEK procedure challenges that include iris defects and aphakia may be overcome by stepwise planning of the procedure.
Descemet’s Stripping-Automated Endothelial Keratoplasty for Traumatic Aniridia and Aphakia  [PDF]
Sabah S. Jastaneiah
Case Reports in Ophthalmological Medicine , 2012, DOI: 10.1155/2012/982657
Abstract: This Interventional case reports a challenging case of descemet’s stripping-automated endothelial keratoplasty (DSAEK) in a young male patient with traumatic aniridia, aphakia, and corneal edema. Surgery was planned in two stages; first was implantation of aniridia intraocular lens (AIOL), few months later, DSAEK procedure was performed. Successful outcome of both procedures was achieved as measured by the stability of the AIOL, clarity of the cornea, attachment of the lenticule, and improvement in vision. Aniridia implant supports a sufficient amount of air in the anterior chamber especially if the posterior segment is well formed, while providing the required lens power to improve vision. DSAEK procedure challenges that include iris defects and aphakia may be overcome by stepwise planning of the procedure. 1. Introduction Descemet stripping automated endothelial keratoplasty (DSAEK) is a procedure used for target replacement of a dysfunctional endothelial cell layer [1]. It has many advantages over conventional penetrating keratoplasty (PKP) in terms of faster visual rehabilitation, induced refractive error (refractive neutral), minimal ocular surface-related changes including sutures and surface-keratopathy-related complications [1, 2]. One of the most important advantages of this procedure over conventional keratoplasty is the maintenance of the structural integrity of the eye, especially in the younger patients where trauma is a higher possibility [3]. Surgically challenging cases have been described in the literature including cases with Iridocorneal Endothelial Syndrome (ICE) [4], aniridia and aphakia [5], complex anterior chambers with anterior chamber lenses [6, 7], post keratoplasty [8], and pediatric patients [5, 9–11]. The aniridia intraocular lenses or the iris reconstruction intraocular lenses can be used to correct congenital and traumatic aniridia. These lenses are designed for scleral fixation or sulcus fixation, depending on the clinical condition of the zonulae and the sufficiency of the capsular support. Indications of the implants are aniridia or iris coloboma to eliminate glare and control the amount of light that enters the eye. These lenses can provide additional optical correction and they come in different sizes, shapes, and color (rings or implants). Patients with combined traumatic aniridia, aphakia, and endothelial failure can enjoy the advantages of the DSAEK procedure in addition to the benefits of an implantable aniridia intraocular lens (IOL). Here, I describe a stepwise approach to manage a case of a young patient
Descemet stripping and endothelial keratoplasty in endothelial dysfunctions: Three-month results in 75 eyes  [cached]
Basak Samar
Indian Journal of Ophthalmology , 2008,
Abstract: Purpose: To analyze the results of Descemet stripping and endothelial keratoplasty (DSEK) in the first consecutive 75 cases. Materials and Methods: Prospective, non-randomized, non-comparative interventional case series. Seventy-five eyes of 75 patients with endothelial dysfunctions of different etiology, scheduled for DSEK, were included in this study. Healthy donor cornea with a cell count of> 2000 cells/sq mm was considered for transplantation in each case. Indications, operative problems and postoperative complications were noted. Best corrected visual acuity (BCVA), refractive and keratometric astigmatism, central corneal thickness (CCT) and endothelial cell density (ECD) were analyzed for each patient after a minimum follow-up of three months. Results: Main indication was pseudophakic corneal edema and bullous keratopathy in 53 (70.7%) eyes. Seventeen (22.7%) cases had moderate to severe Fuchs′ dystrophy with various grades of cataract; and DSEK was combined with manual small-incision cataract surgery (MSICS) with posterior chamber intraocular lens (PCIOL) in those cases. After three months, BCVA was 20/60 or better in 62 (82.7%) cases. Mean refractive and keratometric astigmatism were 1.10 ± 0.55 diopter cylinder (DCyl) and 1.24 ± 0.92 DCyl. The CCT and ECD were 670.8 ± 0.32 μm and 1485.6 ± 168.6/sq mm respectively. The mean endothelial cell loss after three months was 26.8 ± 4.24% (range: 13.3-38.4%). Dislocation of donor lenticule occurred in six (8.0%) eyes. Graft failure occurred in one case. Conclusions: Descemet stripping and endothelial keratoplasty is a safe and effective procedure in patients with endothelial dysfunctions with encouraging surgical and visual outcomes. It can be safely combined with MSICS with PCIOL in patients with moderate to severe Fuchs′ dystrophy with cataract.
Descemet stripping endothelial keratoplasty: One-year follow-up  [PDF]
Nikoli? Ljubi?a,Jovanovi? Vesna
Srpski Arhiv za Celokupno Lekarstvo , 2010, DOI: 10.2298/sarh1012690n
Abstract: Introduction. Sutureless transplantation of endothelium on a thin stromal carrier was introduced under the name of Descemet stripping endothelial keratoplasty (DSEK) in 2004. It has become the treatment of choice of corneal oedema due to endothelial dysfunction. Objective. To investigate posterior lamellar graft attachment, central corneal thickness (CCT), astigmatism, and best corrected visual acuity (BCVA) during one-year follow-up. Methods. Surgery was performed on one eye of 11 patients with pseudophakic bullous keratopathy and Fuchs’ dystrophy. The graft thick 150-200 μm and 8.0 mm in diameter was detached manually. The carrier of the recipient cornea was created by DSEK. The graft was folded in half, introduced into the anterior orbital chamber through a 5.0 mm cut on the limbus and attached by air bubble along the internal side of the recipient cornea. CCT and astigmatism were evaluated by corneal topography, and graft attachment by biomicroscopy. Results. One year after surgery, all grafts remained attached. Primary graft failure occurred in three eyes, probably due to the crushing effect of the forceps. BCVA was 20/30 (2 eyes), and 20/40 (6 eyes), CCT 643-728 μm, and astigmatism 1.1 D to 2.9 D. The peak values were reached three months after surgery, and did not change much afterwards. Conclusion. This is the first report on the long-term results of DSEK in our literature. The results are similar to those obtained by more experienced DSEK surgeons, and suggest that this procedure is safe and successful.
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