Intraoperative S-Stamp Enabled Rescue of 3 Inverted Descemet Membrane Endothelial Keratoplasty Grafts
| Autor: | Michael D. Straiko, Peter B. Veldman, Mark A. Terry, Zachary M. Mayko |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Insufflation
Graft Rejection Male Reoperation medicine.medical_specialty Graft failure Intraoperative Complication Descemet membrane Corneal Pachymetry Iatrogenic Disease Sulfur Hexafluoride Visual Acuity Cell Count 03 medical and health sciences 0302 clinical medicine Fiducial Markers Medicine Humans Corneal pachymetry Primary graft failure Aged medicine.diagnostic_test Medical Errors business.industry Endothelium Corneal Fuchs' Endothelial Dystrophy Corneal Endothelial Cell Loss Standard technique Surgery Ophthalmology surgical procedures operative Descemet Stripping Endothelial Keratoplasty 030221 ophthalmology & optometry Female business 030217 neurology & neurosurgery |
| Zdroj: | Cornea. 36(6) |
| ISSN: | 1536-4798 |
| Popis: | Purpose To report the clinical outcomes of 3 Descemet membrane endothelial keratoplasty (DMEK) grafts, in which an upside down DMEK graft orientation was discovered after SF6 gas insufflation of the anterior chamber and the orientation was then corrected intraoperatively. Methods A total of 371 consecutive DMEK cases using an S-stamp were analyzed and found to include 3 cases in which the DMEK graft was initially elevated with SF6 gas in an upside down orientation, as demonstrated intraoperatively by the S-stamp. In each case, the graft was immediately manipulated into the proper orientation and the rescued case completed using our standard technique. The postoperative complications of these cases were reported and the percentage of endothelial cell loss at 6 months was compared with that of cases in this series without this rare intraoperative complication. Results All 3 rescued grafts achieved successful recipient corneal clearance and improved vision for the patient. There was no graft failure, rebubble, or rejection in these 3 cases. The average 6-month endothelial cell loss in the 3 initially inverted grafts was 51%, 58.3%, and 67% compared with 31.6% (SD ± 17.4%) in the series at large. Conclusions Incorporation of a stromal-sided S-stamp has been previously shown to reduce the risk of iatrogenic primary graft failure through the prevention of upside down graft implantation. In these 3 instances, although the stamp did not prevent initial upside down graft elevation, it did allow the surgeon to immediately recognize this rare problem, correct it intraoperatively, and prevent iatrogenic graft failure in each case. |
| Databáze: | OpenAIRE |
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