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Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology 1/2017

08.10.2016 | Cornea

Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study

verfasst von: Sonja Heinzelmann, Daniel Böhringer, Philipp Eberwein, Thomas Reinhard, Philip Maier

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 1/2017

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Abstract

Purpose

Although the functional results following DMEK are better than after DSAEK, DSAEK still seems to be the standard procedure, as surgeons fear losing grafts during DMEK graft preparation. Therefore, eye banks offer precut DMEK grafts for direct use by the surgeon. Here, we analysed the functional results and complication rates for a precut technique compared to fresh preparations.

Methods

We retrospectively compared 453 standard to 11 precut (1–2 days before surgery) DMEK cases. Precut preparations did not differ from the standard preparation, except that the preparation was stopped after trephination with the graft still attached in a small central area. The preparation had to be completed before surgery by peeling off the centrally attached part of the graft. This technique was first tested in an experimental series of 14 grafts, which were unsuitable for transplantation. All surgeries were performed in the same standardized way.

Results

There was no significant endothelial cell loss during the storage period following precut preparation. We found a statistically significantly higher endothelial cell loss and graft failure rate for the precut grafts.

Conclusion

Because of the statistically significant higher graft failure rate in the precut group, we stopped using this technique, so the numbers in this retrospective case series are small. The higher graft failure rate may be explained by (ultra)structural changes in the DMEK graft (e.g. accumulation of dextran) during the second storage period. Therefore, careful evaluation is recommended before using precut DMEK grafts stored in dextran containing media in order to avoid early primary graft failures.
Literatur
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Metadaten
Titel
Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study
verfasst von
Sonja Heinzelmann
Daniel Böhringer
Philipp Eberwein
Thomas Reinhard
Philip Maier
Publikationsdatum
08.10.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 1/2017
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-016-3499-3

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