Technique to F mark Descemet-stripping endothelial keratoplasty graft
| Autor: | Sandro Soldati, Roberto Cian, Romeo Altafini, Pietro Viola |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Descemet membrane Endothelium business.industry Donor tissue medicine.disease Sensory Systems Ophthalmology medicine.anatomical_structure Donor graft Immunologic graft rejection Descemet Stripping Endothelial Keratoplasty medicine Surgery Donor cornea Endothelial dysfunction business |
| Zdroj: | Journal of Cataract and Refractive Surgery. 40:1743-1744 |
| ISSN: | 0886-3350 |
| Popis: | Endothelial keratoplasty has evolved into a popular alternative to penetrating keratoplasty (PKP) for the treatment of endothelial dysfunction. Since its introduction, endothelial keratoplasty has progressed toward a graft thickness as thin as possible. During this progression, various technical and surgical challenges had to be overcome. Although the earliest iterations were challenging and were not widely adopted, the iteration known as Descemet-stripping endothelial keratoplasty (DSEK) has gained widespread acceptance. Studies show that a newer endothelial keratoplasty iteration, Descemet membrane endothelial keratoplasty (DMEK), provides an even faster and better visual recovery than DSEK. In addition, DMEK significantly reduces the risk for immunologic graft rejection episodes compared with the risk in DSEK or PKP. Although the DMEK donor tissue, consisting of the bare endothelium and Descemet membrane without any stroma, is more challenging to prepare and position in the recipient eye, recent improvements in instrumentation and surgical techniques are increasing the ease and the reliability of the procedure. In 2013, Muraine et al. described a reliable technique that significantly improved the safety and repeatability of donor graft preparation, which also led to some improvement in donor graft management once inside the anterior chamber. The proper orientation of the graft remains a matter of surgeon experience. The technique we describe would fill this gap and although it has been derived from Muraine et al.’s technique, it might be applicable to some of the previous techniques. According to Muraine et al.’s technique, the donor graft is obtained by hydrodissecting a donor cornea placed on an artificial anterior chamber filled with air, endothelium side up. After this is completed, the Descemet–endothelium complex will be lying on the inverted corneal stroma. The lamella is now folded in 3 parts, envelope style, to fold the graft with the endothelium inside. At this point, the original technique is modified. The stroma next to the folded graft is gently pressed and a straight flat spatula painted with gentian violet on the inferior side is slid under the graft to obtain a straight groove running underneath the folded graft with a violet line painted on the stroma. After the |
| Databáze: | OpenAIRE |
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