Ultrastructural findings in graft failure after Descemet membrane endothelial keratoplasty (DMEK) and new triple procedure.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
entrez:
15
5
2019
pubmed:
15
5
2019
medline:
4
6
2019
Statut:
ppublish
Résumé
To investigate factors that influence graft failure after Descemet membrane endothelial keratoplasty (DMEK) based on transmission electron microscopy results.Retrospective observational case series.This single center study included 16 eyes of 16 patients with penetrating keratoplasty (n = 14) or repeat DMEK (n = 2) following graft failure after DMEK. The main outcome measures were ultrastructural changes in the explanted graft on transmission electron microscopy, best-corrected visual acuity, and central corneal thickness.The mean preoperative and postoperative best-corrected visual acuity was 1.01 ± 0.54 logMAR and 0.56 ± 0.37 logMAR. The mean central corneal preoperative and postoperative thickness was 667 ± 187 μm and 511 ± 42 μm. Visual acuity and central corneal thickness improved significantly (P = .001/P = .003) after repeat surgery. Electron microscopy showed that 3 of 14 corneas showed upside down transplantation, and 3 corneas had pigmented cells or pigment granules at the Descemet-stroma interface. Further, 9 of 16 specimens showed a posterior collagenous layer deposited onto the Descemet membrane (average thickness 5.1 ± 6.2 μm; ranged 0.65-20 μm); this did not correlate significantly with the time between the original and repeat keratoplasty. Of 16 original grafts, 7 showed ultrastructural anomalies of the Descemet membrane, but one excised cornea showed no Descemet membrane pathologies.The majority of eyes with graft failure after DMEK showed ultrastructural changes in the Descemet membrane. It is crucial to assess donor tissue quality and to conduct graft marking before surgery to avoid immediate or delayed graft failure after DMEK. Nevertheless, repeat keratoplasty provided significant improvement in central corneal thickness and visual acuity.
Identifiants
pubmed: 31083187
doi: 10.1097/MD.0000000000015493
pii: 00005792-201905100-00039
pmc: PMC6531070
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15493Références
Melles GR, Ong TS, Ververs B, et al. Descemet membrane endothelial keratoplasty (DMEK). Cornea 2006;25:987–90.
Flockerzi E, Maier P, Böhringer D, et al. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-section cornea and its keratoplasty registry. Am J Ophthalmol 2018;188:91–8.
Röck T, Bartz-Schmidt KU, Röck D, et al. Refractive changes after Descemet membrane endothelial keratoplasty. Ophthalmologe 2014;111:649–53.
Li S, Liu L, Wang W, et al. Efficacy and safety of Descemet's membrane endothelial keratoplasty versus Descemet's stripping endothelial keratoplasty: a systematic review and meta-analysis. PLoS One 2017;12:12epub, doi://10.1371/journal.pone.0182275.
doi: //10.1371/journal.pone.0182275
Cirkovic A, Schlötzer-Schrehardt U, Weller JM, et al. Clinical and ultrastructural characteristics of graft failure in DMEK: 1-year results after repeat DMEK. Cornea 2015;34:11–7.
Brockmann T, Brockmann C, Maier AK, et al. Clinicopathology of graft detachment after Descemet's membrane endothelial keratoplasty. Acta Ophthalmol 2014;92:e556–61.
Greiner MA, Rixen JJ, Wagoner MD, et al. Diabetes mellitus increases risk of unsuccessful graft preparation in Desemet membrane endothelial keratoplasty: a multicenter study. Cornea 2014;33:1129–33.
Schlötzer-Schrehardt U, Bachmann BO, Laaser K, et al. Characterization of the cleavage plane in Descemet's membrane endothelial keratoplasty. Ophthalmology 2011;118:1950–7.
Heinzelmann S, Hüther S, Böhringer D, et al. Influence of donor characteristics on Descemet membrane endothelial keratoplasty. Cornea 2014;33:644–8.
Weller JM, Schlötzer-Schrehardt U, Tourtas T, et al. Influence of ultrastructural corneal graft abnormalities on the outcome of Descemet membrane endothelial keratoplasty. Am J Ophthalmol 2016;169:58–67.
Matsuzawa A, Hayashi T, Oyakawa I, et al. Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty. BMJ Open Ophthalmol 2017;1:e000080.
Bachmann BO, Schrittenlocher SA, Schaub F, et al. Complications of DMEKeratoplasty: Avoid, recognize and treat. Klin Monbl Augenheilkd 2017;234:1354–61.
Quilendrino R, Rodriguez-Calvo de Mora M, Baydoun C, et al. Prevention and management of Descemet membrane endothelial keratoplasty complications. Cornea 2017;36:1089–95.
Peraza-Nieves J, Baydoun L, Dapena I, et al. Two-year clinical outcome of 500 consecutive cases undergoing Descemet membrane endothelial keratoplasty. Cornea 2017;36:655–60.
Guerra FP, Anshu A, Price MO, et al. Descemet's membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival and endothelial cell loss. Ophthalmology 2011;118:2368–73.
Ham L, van der Wees J, Melles GRF. Causes of primary donor failure in Descemet membrane endothelial keratoplasty. Am J Ophthalmol 2008;145:639–44.
Laaser K, Bachmann BO, Horn FU, et al. Donor tissue culture conditions and outcome after Descemet membrane endothelial keratoplasty. Am J Ophthalmol 2011;151:1007–18.
Heinzelmann S, Böhringer D, Eberwein P, et al. Graft dislocation and graft failure following Descemet membrane endothelial keratopasty (DMEK) using precut tissue: a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 2017;255:127–33.
Abdin A, Daas L, Pattmöller M, et al. Negative impact of dextran in organ culture media for pre-stripped tissue preservation on DMEK (Descemet membrane endothelial keratoplasty) outcome. Graefes Arch Clin Exp Ophthalmol 2018;256:2135–42.
Yoeruek E, Hofmann J, Bartz-Schmitz KU. Comparison of swollen and dextran deswollen organ-cultured corneas for Descemet membrane dissection preparation: Histological and ultrastructural findings. Invest Ophthalmol Vis Sci 2013;54:8036–40.
Bayyoud T, Röck D, Hofmann J, et al. Precut technique for Descemet's membrane endothelial keratoplasty, preparation and storage in organ culture. Klin Monbl Augenheilkd 2012;229:621–3.
Parekh M, Ruzza A, Ferrari S, et al. Preservation of preloaded DMEK lenticules in dextran and non-dextran-based organ culture medium. J Ophthalmol 2016;2016:5830835.
Seitz B, Daas L, Bischoff-Jung M, et al. Anatomy-based DMEK wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach Descemet membrane endothelial keratoplasty. Clin Anat 2018;31:16–27.
Yoeruek E, Hoffmann J, Bartz-Schmidt KU. Histological and ultrastructural findings of corneal tissue after failed Descemet membrane endothelial keratoplasty. Acta Ophthalmol 2014;92:213–6.