Descemet Membrane Endothelial Keratoplasty: Preliminary Results of a Donor Insertion Pull-through Technique Using a Donor Mat Device
Descemet Membrane Endothelial Keratoplasty: Preliminary Results of a Donor Insertion Pull-through Technique Using a Donor Mat Device
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DOI：
10.1016/j.ajo.2016.08.023
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发表时间：
2016-11-01
影响因子：
4.2
通讯作者：
Tan, Donald
中科院分区：
文献类型：
--
作者：
Ang, Marcus;Mehta, Jodhbir S.;Tan, Donald
目得：评价一种使用EndoGlide pull-through device.DESIGN的后弹力层角膜内皮移植术（DMEK）供体插入的新技术：前瞻性介入性病例系列。方法：我们由一名外科医生在30例患者中使用EndoGlide技术和原型供体载体器械（Descemet Mat或D-Mat）进行DMEK（包括学习曲线）。从我们的前瞻性新加坡角膜移植登记处跟踪临床数据和供体和受体特征。主要结果的措施是术中并发症和术后移植物脱离和原发性移植失败的发生率在3个月内从surgery.RESULTS：在我们的初步研究30例患者（73%女性，平均年龄64.5 +/- 8.3岁），我们观察到3例（10%）的部分供体脱离需要再泡和1（3%）原发性供体失败。20/30眼（66.7%）达到了>= 20/25的3个月最佳视力矫正视力。6个月内皮细胞损失从65% +/- 13%降低到48% +/- 11%（P = 0.02），比较第一个和最后15个病例。除了1例纤维蛋白形成过多的病例外，我们没有发生与供体组织插入、组织展开不完全、供体组织错位或方向不正确相关的任何进一步术中并发症。“结论：我们的研究表明，所描述的技术允许供体控制和插入在正确的方向与内皮面朝下。需要进一步的研究来证实这种DMEK供体插入技术是否可以减少内皮细胞损失和更好的移植物存活。(C)2016 Elsevier Inc.版权所有
PURPOSE: To evaluate a novel technique of Descemet membrane endothelial keratoplasty (DMEK) donor insertion using the EndoGlide pull-through device.DESIGN: Prospective, interventional cases series.METHODS: We performed DMEK using the EndoGlide technique with a protoype donor carrier device (Descemet Mat, or D-Mat) in 30 patients by a single surgeon (including learning curve). Clinical data and donor and recipient characteristics were tracked from our prospective Singapore Corneal Transplant Registry. Main outcome measures were intraoperative complications and the incidence of postoperative graft detachment and primary graft failures within 3 months from surgery.RESULTS: In our preliminary study of 30 eyes in 30 patients (73% female, mean age 64.5 +/- 8.3 years), we observed 3 cases (10%) of partial donor detachment requiring rebubbling and 1 (3%) primary donor failure. Twenty of 30 eyes (66.7%) achieved >= 20/25 3-month best spectacle-corrected visual acuity. Six-month endothelial cell loss reduced from 65% +/- 13% to 48% +/- 11% (P = .02) comparing the first and last 15 cases. With the exception of 1 case with excessive fibrin formation, we did not experience any further intraoperative complications related to donor tissue insertion, incomplete tissue unfolding, donor tissue malposition, or incorrect orientation. "CONCLUSION: Our study suggests that the described technique allows for donor control and insertion in the correct orientation with the endothelium facing down. Further studies are required to confirm if this DMEK donor insertion technique can lead to reduced endothelial cell loss and better graft survival. (C) 2016 Elsevier Inc. All rights reserved