THE PARTIAL DESCEMET'S STRIPPING WITH TRANSPLANTATION OF DESCEMET'S TRANSPLANT UNDER ENDOTHELIAL DYSTROPHY OF CORNEA

Abstract


The DMEK technique is applied five times more rarely than DS(A)EK despite that DMEK provides higher functional result. The main causes are technical "convolution" of implementation, long period of training, accompanied by prolonged operations, higher reject control of donor's tissue, increased rate of dependency of endothelium and mismatch of transplant. Therefore, an efficient technique is needed similar to DMEK though simpler than DMEK.The purpose of study. To analyze the results of implantation of Descemet's transplant (DMET) in patients with endothelium dystrophy of cornea (Fuchs) on the basis of limited clinical observations.Material of study. In two years, DMET was implemented to 12 patients. The study included 6 patients with average age of 60±18 years (from 29 to 80 years). All female patients had primary endothelial dystrophy and one male patient had secondary endothelial dystrophy. The visual acuity prior to DMET in average made up to 0,2±0,2 (from 0,01 to 0,5). The average CTR according optical coherent eye tomography made up to 685±53 µm (from 622 to 749 µm). Results. Within available periods of observation, resorption of edema of cornea takes place in 4 patients (67%) and visual acuity increased from average 0,2±0,1 to 0,45±0,3. In various periods density of endothelium cells varied from 549 to 689 kl per mm2. The indices of optical coherent eye tomography decreased from pre-operational 685±53 µm to 553±15 µm. Conclusion. The results testify efficiency of DMET. The period of restoration of transparency of cornea can vary from 1 to 6 months. The indices of density of endothelium cells are inferior to indices after DMEK. Also, DMET is ineffective in case of secondary dystrophy and at most efficient on previously non-operated eyes.

Full Text

Restricted Access

About the authors

Oganes G. Oganesyan

The Helmholtz Moscow research institute of eye diseases of Minzdrav of Russia

Email: oftalmolog@mail.ru
105062, Moscow, Russian Federation
doctor of medical sciences, leading researcher of the department of traumatology and reconstructive surgery the Helmholtz Moscow research institute of eye diseases of Minzdrav of Russia, 105062, Moscow, Russian Federation

A. A Grdikanyan

The Helmholtz Moscow research institute of eye diseases of Minzdrav of Russia

105062, Moscow, Russian Federation

S. S Yakovleva

The Helmholtz Moscow research institute of eye diseases of Minzdrav of Russia

105062, Moscow, Russian Federation

V. R Getadaryan

The Helmholtz Moscow research institute of eye diseases of Minzdrav of Russia

105062, Moscow, Russian Federation

References

  1. Van Dijk K., Ham L., Tse W.H., Liarakos V.S., Quilendrino R., Yeh R.Y. et al. Near complete visual recovery and refractive stability in modern corneal transplantation: Descemet membrane endothelial keratoplasty (DMEK). Cont. Lens. Anterior Eye. 2013; 36(1): 13-21.
  2. Guerra F.P., Anshu A., Price M.O., Giebel A.W., Price F.W. Descemet’s membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss. Ophthalmology. 2011; 118(12): 2368-73.
  3. Оганесян О.Г., Нероев В.В., Гундорова Р.А., Сметанина М.А., Данилова Д.Ю. Результаты эндотелиальной кератопластики. Часть 2. Трансплантация десцеметовой мембраны с эндотелием (DMEK). Рефракционная хирургия и офтальмология. 2001; 11(1): 24-30.
  4. Оганесян О.Г., Нероев В.В., Гундорова Р.А., Данилова Д.Ю., Сметанина М.А. Результаты эндотелиальной кератопластики. Часть 1. Неавтоматизированная эндотелиальная кератопластика (DSEK). Катарактальная и рефракционная хирургия. 2010; 10(4): 17-24.
  5. Оганесян О.Г., Нероев В.В., Гундорова Р.А., Данилова Д.Ю., Сметанина М.А. «Сэндвич-кератит» после неавтоматизированной эндокератопластики сквозного кератотрансплантата. Российский офтальмологический журнал. 2010; 3(3): 31-5.
  6. ParkC.Y., LeeJ.K., Gore P.K., Lim C.Y., Chuck R.S. Keratoplasty in the United States: A 10-Year Review from 2005 through 2014. Ophthalmology. 2015; 122(12): 2432-42
  7. Сметанина М.А. Микроинвазивная десцеметопластика в лечении эндотелиальной дистрофии роговицы: Автореф. дисс. ... канд. мед. наук. М.; 2011
  8. Balachandran C., Ham L., Verschoor C.A., Ong T.S., van der Wees J., Melles G.R. Spontaneous corneal clearance despite graft detachment in descemet membrane endothelial keratoplasty. Am. J. Ophthalmol. 2009; 148(2): 227-34.
  9. Dirisamer M., Dapena I., Ham L., van Dijk K., Oganesyan O., Frank L.E., et al. Patterns of corneal endothelialization and corneal clearance after Descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy. Am. J. Ophthalmol. 2011; 152(4): 543-55.
  10. Zafirakis P., Kymionis G.D., Grentzelos M.A., Livir-Rallatos G. Corneal graft detachment without corneal edema after Descemet stripping automated endothelial keratoplasty. Cornea. 2010; 29(4): 456-8.
  11. Ziaei M., Barsam A., Mearza A. Spontaneous corneal clearance despite graft removal in Descemet stripping endothelial keratoplasty in Fuchs endothelial dystrophy. Cornea. 2013; 32(7): 164-6.
  12. Shah R.D., Randleman J.B., Grossniklaus H.E. Spontaneous corneal clearing after Descemet’s stripping without endothelial replacement. Ophthalmology. 2012; 119(2): 256-60.
  13. Jacobi C., Zhivov A., Korbmacher J., Falke K., Guthoff R., Schlötzer-Schrehardt U., et al. Evidence of endothelial cell migration after Descemet membrane endothelial keratoplasty. Am. J. Ophthalmol. 2011; 152(4): 537-42.
  14. Stewart R., Hiscott P.S., Kaye S.B. Endothelial migration and new Descemet membrane after endothelial keratoplasty. Am. J. Ophthalmol. 2010; 149(4): 683-4.
  15. Lagali N., Stenevi U., Claesson M., FagerholmP., Hanson C., Weijdegård B., et al. Donor and recipient endothelial cell population of the transplanted human cornea: a two-dimensional imaging study. Invest. Ophthalmol. Vis. Sci. 2010; 51(4): 1898-904.
  16. Joyce N.C. Proliferative capacity of corneal endothelial cells. Exp. Eye Res. 2012; 95(1): 16-23.
  17. Singh G. Mitosis and cell division in human corneal endothelium. Ann. Ophthalmol. 1986; 18(3): 88-90, 93-4.
  18. Joyce N.C. Cell cycle status in human corneal endothelium. Exp. Eye Res. 2005; 81(6): 629-38.
  19. Bednarz J., Rodokanaki-von Schrenck A., Engelmann K. Different characteristics of endothelial cells from central and peripheral human cornea in primary culture and after subculture. In Vitro Cell Dev. Biol. Anim. 1998; 34(2): 149-53.
  20. Zaniolo K., Bostan C., Rochette Drouin O., Deschambeault A., Perron M.C., Brunette I. et al. Culture of human corneal endothelial cells isolated from corneas with Fuchs endothelial corneal dystrophy. Exp. Eye Res. 2012; 94(1): 22-31.
  21. Walshe J., Harkin D.G. Serial explants culture provides novel in sights in to the potential location and phenotype of corneal endothelial progenitor cells. Exp. Eye Res. 2014; 127(10): 9-13.
  22. Mimura T., Joyce N.C. Replication competence and senescence in central and peripheral human corneal endothelium. Invest. Ophthalmol. Vis. Sci. 2006; 47(4): 1387-96.
  23. McGowan S.L., Edelhauser H.F., Pfister R.R, Whikehart D.R. Stem cell markers in the human posterior limbus and corneal endothelium of unwounded and wounded corneas. Mol. Vis. 2007; 18(13): 1984-2000.
  24. Whikehart D.R., Parikh C.H., Vaughn A.V., Mishler K., Edelhauser H.F. Evidence suggesting the existence of stem cells for the human corneal endothelium. Mol. Vis. 2005; 26(11): 816-24.
  25. He Z., Campolmi N., Gain P., Ha Thi B.M., Dumollard J.M., Duband S. et al. Revisited microanatomy of the corneal endothelial periphery: new evidence for continuous centripetal migration of endothelial cells in humans. Stem Cells. 2012; 30(11): 2523-34.
  26. Dirisamer M., Ham L., Dapena I., van Dijk K., Melles G. Descemet Membrane Endothelial Transfer: «Free-floating» donor Descemet implantation as a potential alternative to keratoplasty. Cornea. 2012; 31(2): 194-7.
  27. Ham L., Dapena L., Moutsouris K., Melles G. Persistent corneal edema after descemetorhexis without corneal graft implantation in a case of Fuchs endothelial dystrophy. Cornea. 2011; 30(2): 248-9.
  28. Dirisamer M., Yeh R.Y., van Dijk K., Ham L., Dapena I., Melles G.R. Recipient endothelium may relate to corneal clearance in Descemet membrane endothelial transfer. Am. J. Ophthalmol. 2012; 154(2): 290-6.

Statistics

Views

Abstract - 41

PDF (Russian) - 0

Cited-By


Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2017 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies