TY - JOUR
T1 - Comparison of Descemet stripping under continuous air flow, manual air injection and balanced salt solution for DMEK
T2 - a pilot study
AU - Gabbay, I. E.
AU - Bahar, I.
AU - Nahum, Y.
AU - Livny, E.
N1 - Publisher Copyright:
© 2017, Springer-Verlag Berlin Heidelberg.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background: Descemet’s membrane endothelial keratoplasty (DMEK) involves removal of the recipient’s Descemet membrane (DM) prior to transplanting the donor’s DM. When using balanced salt solution (BSS) or ophthalmic viscosurgical devices (OVDs), visualization of the host’s DM during its stripping may be inadequate and may result in Descemet remnants and could lead to sub-optimal surgical results. Previous articles described excellent visualization when utilizing air injection but this requires repeated air injection into the anterior chamber (AC). We present a pilot study that compares different techniques under which DM stripping can be performed: with continuous automated air infusion, with manual air infusion, and with BSS. Methods: We retrospectively compared video footage of DM stripping with BSS, with continuous air and with manual injection of air into the AC to determine DM stripping duration and the number of times the surgeon had to insert and retrieve a surgical instrument from the AC. Results: Thirty videos of 10 consecutive cases of the three DM stripping techniques were evaluated. DM stripping duration was 3.26 (±1.32), 3.92 (±1.2) and 12.9 (±3.98) minutes for BSS, continuous air flow, and manual air injection, respectively. Frequency of instrument retrieval (FIR) was 3.6 (±1.71), 1.5 (±0.71) and 15.1 (±3.28) for BSS, continuous air flow, and manual air injection, respectively. Continuous air flow and BSS were both statistically different than manual air injection into the AC (p < 0.05), but did not differ from one another statistically. Conclusion: DM stripping during posterior lamellar surgery is imperative for favorable post-operative results and prevention of complications. Performing this step under air in the AC contributes to better visualization and an efficient surgery.
AB - Background: Descemet’s membrane endothelial keratoplasty (DMEK) involves removal of the recipient’s Descemet membrane (DM) prior to transplanting the donor’s DM. When using balanced salt solution (BSS) or ophthalmic viscosurgical devices (OVDs), visualization of the host’s DM during its stripping may be inadequate and may result in Descemet remnants and could lead to sub-optimal surgical results. Previous articles described excellent visualization when utilizing air injection but this requires repeated air injection into the anterior chamber (AC). We present a pilot study that compares different techniques under which DM stripping can be performed: with continuous automated air infusion, with manual air infusion, and with BSS. Methods: We retrospectively compared video footage of DM stripping with BSS, with continuous air and with manual injection of air into the AC to determine DM stripping duration and the number of times the surgeon had to insert and retrieve a surgical instrument from the AC. Results: Thirty videos of 10 consecutive cases of the three DM stripping techniques were evaluated. DM stripping duration was 3.26 (±1.32), 3.92 (±1.2) and 12.9 (±3.98) minutes for BSS, continuous air flow, and manual air injection, respectively. Frequency of instrument retrieval (FIR) was 3.6 (±1.71), 1.5 (±0.71) and 15.1 (±3.28) for BSS, continuous air flow, and manual air injection, respectively. Continuous air flow and BSS were both statistically different than manual air injection into the AC (p < 0.05), but did not differ from one another statistically. Conclusion: DM stripping during posterior lamellar surgery is imperative for favorable post-operative results and prevention of complications. Performing this step under air in the AC contributes to better visualization and an efficient surgery.
KW - Corneal transplantation
KW - DMEK
KW - Descemetorhexis
KW - Endothelium
UR - http://www.scopus.com/inward/record.url?scp=85018249137&partnerID=8YFLogxK
U2 - 10.1007/s00417-017-3675-0
DO - 10.1007/s00417-017-3675-0
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C2 - 28456826
AN - SCOPUS:85018249137
SN - 0721-832X
VL - 255
SP - 1605
EP - 1611
JO - Graefe's Archive for Clinical and Experimental Ophthalmology
JF - Graefe's Archive for Clinical and Experimental Ophthalmology
IS - 8
ER -