Comparative evaluation of four Descemet membrane endothelial keratoplasty graft preparation techniques.

Autor: Din N; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.. Electronic address: nizar.din@uhn.ca., Mimouni M; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Slomovic J; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Aldrees S; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Trinh T; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Cohen E; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Gouvea L; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Alshaker S; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Chan CC; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Chew HF; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Singal N; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Rootman DS; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON., Slomovic AR; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.
Jazyk: angličtina
Zdroj: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie [Can J Ophthalmol] 2023 Jun; Vol. 58 (3), pp. 191-197. Date of Electronic Publication: 2022 Feb 11.
DOI: 10.1016/j.jcjo.2022.01.017
Abstrakt: Objective: To compare subjective and objective outcomes of 4 different Descemet membrane endothelial keratoplasty (DMEK) peeling techniques performed by novice surgeons at different stages in their surgical career.
Design: An ex vivo prospective study.
Methods: In the first round, 2 DMEK peeling techniques were pitched against each other: the peripheral scoring and Sinskey dissection technique with the peripheral scoring and microhoe dissection and the peripheral blunt microhoe dissection against the scleral spurectomy and microhoe dissection. Three surgeons with different operative experience performed the peeling. Outcome measures included graft peeling time, surgeon's peeling difficulty grading (on a scale of 1-10, 1 being the easiest and 10 the hardest), number of radial and circumferential tears before and after trephination, and tissue loss. The 2 techniques that performed the best from the first round proceeded to the final round to identify the best overall technique.
Results: In total, 90 tissues (45 pairs) were peeled by 3 surgeons. Following the first-round results, the peripheral scoring and Sinskey dissection and peripheral blunt microhoe dissection proceeded to the final round. There were no significant differences between the groups in terms of peeling times, subjective feeling of difficulty, post-trephination tears, and peeling success rates (P > 0.05 for all). However, the peripheral scoring and Sinskey dissection technique had significantly fewer pretrephination radial tears (1.3 ± 1.3 vs 6.1 ± 5.2, P = 0.007) and circumferential tears (0.6 ± 0.9 vs 1.8 ± 2.1, P = 0.02).
Conclusions: This study demonstrates that the learning curve can be overcome quickly with appropriate DMEK peeling techniques. The peripheral scoring and Sinskey dissection peeling technique allows efficient peeling with fewer related tears.
(Copyright © 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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