The S-stamp in Descemet Membrane Endothelial Keratoplasty Safely Eliminates Upside-down Graft Implantation

详细信息    查看全文

• 作者：Peter B. Veldman ; MD¹ ; ² ; ^{peterbveldman@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Philip K. Dye ; CEBT³ ; Jeffrey D. Holiman ; CEBT³ ; Zachary M. Mayko ; MS³ ; Christopher S. Sá ; les ; MD ; MPH² ; Michael D. Straiko ; MD² ; Joshua D. Galloway ; CEBT³ ; Mark A. Terry ; MD²
• 关键词：DMEK ; Descemet membrane endothelial keratoplasty ; DSAEK ; Descemet stripping automated endothelial keratoplasty
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：123
• 期：1
• 页码：161-164
• 全文大小：418 K

文摘

To present 6-month clinical outcomes from a series of 165 consecutive Descemet membrane endothelial keratoplasty (DMEK) procedures before and after the introduction of a novel stromal-sided S-stamp preparation technique that has decreased the incidence of iatrogenic primary graft failure by eliminating upside-down grafts.

Design

Retrospective nonrandomized comparative case series.

Participants

We included 165 consecutive eyes that had undergone DMEK surgery for Fuchs' or pseudophakic bullous keratopathy. These cases were divided into 2 cohorts: the first cohort comprised 31 cases that used unstamped tissue before the S-stamp was introduced, and the second cohort comprised 133 cases after the S-stamp was incorporated into the standardized technique. A single unstamped DMEK case was performed after the introduction of the S-stamp for a total of 32 unstamped cases.

Methods

Donor materials were prepared at a single eye bank using a standardized technique, which subsequently incorporated the addition of a dry ink gentian violet S-stamp to the stromal side of Descemet membrane. All surgeries were performed at a single clinical site by 5 surgeons (2 attending surgeons and 3 fellows). Two of the 165 DMEK cases were performed for pseudophakic bullous keratopathy (2 cases, 1 in each cohort), and the remaining cases were for Fuchs' endothelial dystrophy. Primary outcome measures were assessed at 6 months and maintained in a prospective institutional review board–approved study.

Main Outcome Measures

We analyzed the 6-month endothelial cell density, incidence of iatrogenic primary graft failure, upside-down graft implantation, and rebubble events.

Results

The S-stamp eliminated upside-down graft implantations (0/133 S-stamped vs 3/32 unstamped) and did not significantly alter 6-month endothelial cell loss (31±17% S-stamped vs 29±14% unstamped; P = 0.62) or frequency of rebubble (17/133 S-stamped vs 1/32 unstamped; P = 0.20).

Conclusion

The incorporation of a stromal-sided S-stamp eliminates iatrogenic primary graft failure owing to upside-down implantation of DMEK grafts, without adversely affecting early postoperative complications or 6-month endothelial cell loss.