Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative.
Autor: | Bhogal M; St Thomas' Hospital, London, United Kingdom.; Dr Shroff's Charity Eye Hospital, Delhi, India.; Singapore National Eye Centre, Singapore.; Reyes-Giobellina Eye Clinic, Córdoba, Argentina.; Kanazawa University Hospital, Kanazawa city, Japan.; Save Sight Institute, Sydney, Australia.; Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.; Moorfields Eye Hospital, London, United Kingdom.; University of Ferrara, Ferrara, Italy.; University of Cologne, Cologne, Germany.; Apollo Hospital, Hyderabad, India.; Gorovoy MD Eye Specialist, Fort Myers, FL.; East Valley Ophthalmology, Mesa, AZ.; Bascom Palmer Eye Hospital, Miami, FL.; Singapore Eye Research Institute, Singapore.; Clinic Com, Medellin, Colombia.; Sorocaba Eye Bank and Department of Ophthalmology and Visual Sciences, Federal University, Sao Paulo, Brazil.; Mayo Clinic, Rochester, MN.; Price Vision Group, Indianapolis, IN.; Wills Eye Hospital, Philadelphia, PA.; Bellevue Precision Vision, Bellevue, WA.; Rothschild Foundation Hospital, Paris, France.; All India Institute of Medical Sciences, Delhi, India.; University of Toronto, Toronto, Canada.; University of Sydney, Sydney, Australia.; Devers Eye Institute, Portland, OR.; University of Illinois, Eye and Ear Infirmary, Chicago, IL.; University of Chicago, Chicago, IL.; Massachusetts Eye and Ear Infirmary, Boston, MA; and.; LV Prasad Eye Institute, Hyderabad, India., Gupta N; Dr Shroff's Charity Eye Hospital, Delhi, India.; Singapore National Eye Centre, Singapore., Giobellina T; Reyes-Giobellina Eye Clinic, Córdoba, Argentina., Kobayashi A; Kanazawa University Hospital, Kanazawa city, Japan., Males J; Save Sight Institute, Sydney, Australia., Mehta JS; Singapore National Eye Centre, Singapore., Romano V; Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Allan B; Moorfields Eye Hospital, London, United Kingdom., Busin M; University of Ferrara, Ferrara, Italy., Cursiefen C; University of Cologne, Cologne, Germany., Fogla R; Apollo Hospital, Hyderabad, India., Gorovoy M; Gorovoy MD Eye Specialist, Fort Myers, FL., McKee Y; East Valley Ophthalmology, Mesa, AZ., Koo E; Bascom Palmer Eye Hospital, Miami, FL., Kocaba V; Singapore Eye Research Institute, Singapore., Mejia LF; Clinic Com, Medellin, Colombia., Moriyama A; Sorocaba Eye Bank and Department of Ophthalmology and Visual Sciences, Federal University, Sao Paulo, Brazil., Patel S; Mayo Clinic, Rochester, MN., Pereira NC; Mayo Clinic, Rochester, MN., Price FW Jr; Price Vision Group, Indianapolis, IN., Rapuano CJ; Wills Eye Hospital, Philadelphia, PA., Talley Rostov A; Bellevue Precision Vision, Bellevue, WA., Saad A; Rothschild Foundation Hospital, Paris, France., Sharma N; Sorocaba Eye Bank and Department of Ophthalmology and Visual Sciences, Federal University, Sao Paulo, Brazil., Slomovic A; University of Toronto, Toronto, Canada., Sutton G; University of Sydney, Sydney, Australia., Terry M; Devers Eye Institute, Portland, OR., Tu E; University of Illinois, Eye and Ear Infirmary, Chicago, IL., Veldman P; University of Chicago, Chicago, IL., Pineda R 2nd; Massachusetts Eye and Ear Infirmary, Boston, MA; and., Vaddavalli PK; LV Prasad Eye Institute, Hyderabad, India. |
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Jazyk: | angličtina |
Zdroj: | Cornea [Cornea] 2024 Dec 17. Date of Electronic Publication: 2024 Dec 17. |
DOI: | 10.1097/ICO.0000000000003758 |
Abstrakt: | Purpose: To identify areas of consensus among experts on the performance of endothelial keratoplasty by using a modified Delphi approach, to help create a framework for novice surgeons to adopt these procedures. Methods: Thirty-one international experts in endothelial keratoplasty participated. Two rounds of electronic survey were followed by a hybrid, virtual meeting. Consensus was set at 75%, and results with agreement between 70% and 75% were deemed as achieving near consensus. Results: A consensus was reached for 98 statements covering the preoperative, intraoperative, and postoperative aspects of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Four statements achieved near consensus, and consensus could not be achieved for 11 statements. For DMEK, the panel supported a peel technique to prepare tissue for endothelium out DMEK, implanted via an injector and supported by a near full air/gas fill as a baseline procedure onto which more advanced techniques can be built. DMEK tissue should be marked to ensure correct orientation. An inferior peripheral iridotomy should be used to prevent pupil block when a near full air/gas fill in used in endothelial keratoplasty (EK). Descemet stripping automated endothelial keratoplasty was considered preferable to Descemet stripping endothelial keratoplasty where access to microkeratome preparation was available. Conclusions: The Delphi process allowed areas of consensus on the performance of EK to be established by a group of international experts. The statements generated are a helpful framework for novice surgeons learning EK. Further research is needed to help determine what specific tomographic features indicate EK, when guttae are considered visually significant and how to approach combined aphakia and endothelial dysfunction. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
Databáze: | MEDLINE |
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