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Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate

Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate
Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate
Aim: To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty (TM-DSEK).

Methods: Donor material was soaked in balanced salt solution (BSS) for 30min, before being mounted on an artificial anterior chamber (AAC). Rather than BSS, the AAC was filled with filtered air, resulting in a visible reflection at the corneal endothelium-air interface. This reflection served as a landmark for the depth of the dissection, facilitating the creation of a thin lenticule with low risk of perforation. Dissection was commenced at a standardized depth of 500 microns, with no initial pachymetry necessary. Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon. Dissection time, central graft thickness at 2mo and complications were analysed.

Results: Results were similar to other endothelial keratoplasty techniques, despite the cases being performed by a novice DSEK surgeon. Mean dissection time was 7min (range 6-10). One graft perforation occurred (3.45%), but the air tamponaded the break and enabled dissection to be restarted and completed from a different location. Mean central graft thickness after at least two months follow-up was 106 microns (range 25-170).

Conclusion: A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule, or creating a thick graft due to fear of perforating. This modified air-guided technique addresses this problem, and is recommended for surgeons either embarking on the learning curve, or who wish to achieve more consistently thin grafts while reducing perforation rates.
Descemet stripping endothelial keratoplasty, manual donor lenticule dissection, graft thickness, keratoplasty
2222-3959
342–345
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Konstantopoulos, Aristides
c54185a9-1ef3-4b6d-91a3-38de444cc4fb
Anderson, David
ace373df-c58c-4cd4-941f-1a596a62b5a8
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Konstantopoulos, Aristides
c54185a9-1ef3-4b6d-91a3-38de444cc4fb
Anderson, David
ace373df-c58c-4cd4-941f-1a596a62b5a8

Hossain, Parwez, Konstantopoulos, Aristides and Anderson, David (2020) Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate. International Journal of Ophthalmology, 13 (2), 342–345. (doi:10.18240/ijo.2020.02.19).

Record type: Article

Abstract

Aim: To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty (TM-DSEK).

Methods: Donor material was soaked in balanced salt solution (BSS) for 30min, before being mounted on an artificial anterior chamber (AAC). Rather than BSS, the AAC was filled with filtered air, resulting in a visible reflection at the corneal endothelium-air interface. This reflection served as a landmark for the depth of the dissection, facilitating the creation of a thin lenticule with low risk of perforation. Dissection was commenced at a standardized depth of 500 microns, with no initial pachymetry necessary. Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon. Dissection time, central graft thickness at 2mo and complications were analysed.

Results: Results were similar to other endothelial keratoplasty techniques, despite the cases being performed by a novice DSEK surgeon. Mean dissection time was 7min (range 6-10). One graft perforation occurred (3.45%), but the air tamponaded the break and enabled dissection to be restarted and completed from a different location. Mean central graft thickness after at least two months follow-up was 106 microns (range 25-170).

Conclusion: A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule, or creating a thick graft due to fear of perforating. This modified air-guided technique addresses this problem, and is recommended for surgeons either embarking on the learning curve, or who wish to achieve more consistently thin grafts while reducing perforation rates.

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More information

Accepted/In Press date: 7 December 2019
Published date: 18 February 2020
Keywords: Descemet stripping endothelial keratoplasty, manual donor lenticule dissection, graft thickness, keratoplasty

Identifiers

Local EPrints ID: 441757
URI: http://eprints.soton.ac.uk/id/eprint/441757
ISSN: 2222-3959
PURE UUID: 58298c34-407a-4453-8d46-de11cacb1617
ORCID for Parwez Hossain: ORCID iD orcid.org/0000-0002-3131-2395

Catalogue record

Date deposited: 25 Jun 2020 16:48
Last modified: 18 Feb 2021 17:06

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Contributors

Author: Parwez Hossain ORCID iD
Author: Aristides Konstantopoulos
Author: David Anderson

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