THE TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM IN COMPLICATED CLINICAL SITUATIONS

Abstract


The transplantation of Descemet's membrane with endothelium (DMEK) is the most efficient method of treatment of endothelium pathology. However, it is considered that at certain clinical situations DMEK is inappropriate. The purpose of study is to analyze the results of DMEK in complicated clinical situations. Materials and methods. The sampling included 14 patients (16 eyes) with pathology of endothelium of primary (19%) and secondary (81%) genesis and with concomitant alterations, including: total lack of vitreous (19%), non-posterior chamber pseudophakia (25%), presence of Ahmed drainage (25%), artificial lensiris diaphragm (12%), corneal ectasia combined with toric artiphakia (12%), penetrating scar of cornea (6%). Prior to operation, average visual acuity amounted to 0,04±0,05. The subtotal DMEK was applied to 15 eyes and in one case ¼ DMEK was implemented. In 2 cases cornea of donor had keratotomic incisions and in one case Descemetotransplant was formed from residual back layers of cornea after formation of front layer wise transplant using femtosecond laser. The results. No intra-operational complications were established. In 19% of cases a partial mismatch of transplant took place. The repeated DMEK was implemented in 1 case. The recovery of transparency of cornea and increasing of vision acuity were achieved in 94% of cases. In 6 months after operation an average central thickness of cornea amounted to 522±46 μm and density of endothelium cells in average amounted to 1541±486 kl/mm2. Conclusion. The application of DMEK in complicated situations ensures high biological and functional results and is accompanied with minimal number of complications. The procurement of expertise in endothelium surgery, it is appropriate to apply DMEK in all cases of pathology of endothelium.

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About the authors

Oganes G. Oganesyan

«The Helmholtz Moscow Research Institute of Eyes Diseases» of the Ministry of Health of the Russian Federation

Email: oftalmolog@mail.ru
105062, Moscow, Russian Federation
doctor of medical sciences, senior researcher of the Department of Traumatology and Reconstructive Surgery «The Helmholtz Moscow Research Institute of Eyes Diseases», 105062, Moscow, Russian Federation

P. V Makarov

«The Helmholtz Moscow Research Institute of Eyes Diseases» of the Ministry of Health of the Russian Federation

105062, Moscow, Russian Federation

A. A Grdikanyan

«The Helmholtz Moscow Research Institute of Eyes Diseases» of the Ministry of Health of the Russian Federation

105062, Moscow, Russian Federation

V. R Getadaryan

«The Helmholtz Moscow Research Institute of Eyes Diseases» of the Ministry of Health of the Russian Federation

105062, Moscow, Russian Federation

References

  1. Melles G.R. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea. 2006; 25(8): 879-881.
  2. Tourtas T., Laaser K., Bachmann B.O., Cursiefen C., Kruse F.E. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am. J. Ophthalmol. 2012; 153(6): 1082-90.
  3. Dirisamer M., Ham L., Dapena I., Moutsouris K., Droutsas K. Efficacy of descemet membrane endothelial keratoplasty: clinical outcome of 200 consecutive cases after a learning curve of 25 cases. Arch. Ophthalmol. 2011; 129(11): 1435-43.
  4. Ham L., Balachandran C., Verschoor C.A., van. der Wees J., Melles G.R. Visual rehabilitation rate after isolated descemet membrane transplantation: descemet membrane endothelial keratoplasty. Arch. Ophthalmol. 2009; 127(3): 252-5.
  5. Ham L., Dapena I., van Luijk C., van der Wees J., Melles G.R. Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases. Eye (Lond). 2009; 23(10): 1990-8.
  6. Parker J., Dirisamer M., Naveiras M., Tse W.H., van Dijk K., Frank L.E. et al. Outcomes of Descemet membrane endothelial keratoplasty in phakic eyes. J. Cataract Refract. Surg. 2012;38(5): 871-7.
  7. Liarakos V.S., Dapena I., Ham L., van Dijk K., Melles G.R. Intraocular graft unfolding techniques in descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 2013; 131(1): 29-35.
  8. Weller J.M., Tourtas T., Kruse F. Feasibility and outcome of descemet membrane endothelial keratoplasty in complex anterior segment and vitreous disease. Cornea. 2015; 34(11): 1351-7.
  9. Borderie V.M., Loriaut P., Bouheraoua N., Nordmann J.P. Incidence of intraocular pressure elevation and glaucoma after lamellar versus full-thickness penetrating keratoplasty. Ophthalmology. 2016; 123(7): 1428-34.
  10. Speaker M.G., Lugo M., Laibson P.R., Rubinfeld R.S., Stein R.M., Genvert G.I. et al. Penetrating keratoplasty for pseudophakic bullous keratopathy. Management of the intraocular lens. Ophthalmology. 1988; 95(9): 1260-8.
  11. Sugar A. An analysis of corneal endothelial and graft survival in pseudophakic bullous keratopathy. Trans. Am. Ophthalmol. Soc. 1989; 87(4): 762-801.
  12. Mashor R.S., Bahar I., Kaiserman I., Berg A.L., Slomovic A., Rootman D.S. Combined penetrating keratoplasty and implantation of iris prosthesis intraocular lenses after ocular trauma. J. Cataract Refract. Surg. 2011; 37(3): 582-7.
  13. Rickmann A., Szurman P., Januschowski K., Waizel M., Spitzer M.S., Boden K.T., et al. Long-term results after artificial iris implantation in patients with aniridia. Graefes Arch. Clin. Exp. Ophthalmol. 2016; 254(7): 1419-24.
  14. Ni N., Sperling B.J., Dai Y., Hannush S.B. Outcomes after descemet stripping automated endothelial keratoplasty in patients with glaucoma drainage devices. Cornea. 2015; 34(8): 870-5.
  15. Esquenazi S., Rand W. Safety of DSAEK in patients with previous glaucoma filtering surgery. J. Glaucoma. 2010; 19(3): 219-20.
  16. Sng C.C., Mehta J., Tan D.T. Posterior dislocation and immediate retrieval of a descemet stripping automated endothelial keratoplasty graft. Cornea. 2012; 31(4): 450-3.
  17. Suh L.H., Kymionis G.D., Culbertson W.W., O'Brien T.P., Yoo S.H. Descemet stripping with endothelial keratoplasty in aphakic eyes. Arch. Ophthalmol. 2008; 126(2): 268-70.
  18. Perry H.D., Barsam A., Nissirios N., Donnenfeld E.D. Dislocation of the donor graft to the posterior segment in descemet strippingautomated endothelial keratoplasty in eyes with intraocular posterior segment prosthetic irides. Cornea. 2013; 32(3): 375.
  19. Afshari N.A., Gorovoy M.S., Yoo S.H., Kim T., Carlson A.N., Rosenwasser G.O. et al. Dislocation of the donor graft to the posterior segment in descemet stripping automated endothelial keratoplasty. Am. J. Ophthalmol. 2012; 153(4): 638-42.
  20. Sharma A., Gupta P., Viswanadh K.B., Ram J., Dogra M.R., Gupta A. Retrieval of a dropped corneal button from a vitrectomized eye. Ophthalmic Surg. Lasers. 2001; 32(6): 494-5.
  21. Anandan M., Leyland M. Suture fixation of dislocated endothelial grafts. Eye (Lond). 2008; 22(5):718-21.
  22. Patel A.K., Luccarelli S., Ponzin D., Busin M. Transcorneal suture fixation of posterior lamellar grafts in eyes with minimal or absent iris-lens diaphragm. Am. J. Ophthalmol. 2011; 151(3): 460-4.
  23. Wu W.K., Wong V.W., Chi S.C. Graft suturing for lenticule dislocation after descemet stripping automated endothelial keratoplasty. J. Ophthalmic. Vis. Res. 2011; 6(2): 131-5.
  24. Titiyal J.S., Sachdev R., Sinha R., Tandon R., Sharma N. Modified surgical technique for improving donor adherence in DSAEK in the aphakic vitrectomized eye. Cornea. 2012; 31(4): 462-4.
  25. Yoeruek E., Rubino G., Bayyoud T., Bartz-Schmidt K. Descemet Membrane Endothelial Keratoplasty in Vitrectomized Eyes: Clinical Results. Cornea. 2015; 34(1): 1-5.
  26. Kim M.S., Kim K.N., Kim C. Changes in corneal endothelial cell after ahmed glaucoma valve implantation and trabeculectomy: 1-year follow-up. Korean J. Ophthalmol. 2016; 30(6): 416-25.
  27. Lieberman R.A., Maris P.J., Monroe H.M., Al-Aswad L.A., Bansal R., Lopez R. et al. Corneal graft survival and intraocular pressure control in coexisting penetrating keratoplasty and pars plana Ahmed Glaucoma Valves. Cornea. 2012; 31(4): 350-8.
  28. Akdemir M.O., Acar B.T., Kokturk F., Acar S. Clinical outcomes of trabeculectomy vs. Ahmed glaucoma valve implantation in patients with penetrating keratoplasty: (Trabeculectomy vs. Ahmed galucoma valve in patients with penetrating keratoplasty). Int. Ophthalmol. 2016; 36(4): 541-6.
  29. McDermott M.L., Swendris R.P., Shin D.H., Juzych M.S., Cowden J.W. Corneal endothelial cell counts after Molteno implantation. Am. J. Ophthalmol. 1993; 115(1): 93-6.
  30. Topouzis F., Coleman A.L., Choplin N., Bethlem M.M., Hill R., Yu F. et al. Follow-up of the original cohort with the Ahmed glaucoma valve implant. Am. J. Ophthalmol. 1999; 128(2): 198-204.
  31. Lee E.K., Yun Y.J., Lee J.E., Yim J.H., Kim C.S. Changes in corneal endothelial cells after Ahmed glaucoma valve implantation: 2-year follow-up. Am. J. Ophthalmol. 2009; 148(3): 361-7.
  32. Kim K.N., Lee S.B., Lee Y.H., Lee J.J., Lim H.B., Kim C.S. Changes in corneal endothelial cell density and the cumulative risk of corneal decompensation after Ahmed glaucoma valve implantation. Br. J. Ophthalmol. 2016; 100(3): 933-8.
  33. Heindl L.M., Koch K.R., Bucher F., Hos D., Steven P., Koch H.R. et al. Descemet membrane endothelial keratoplasty in eyes with glaucoma implants. Optom. Vis. Sci. 2013; 90(9): 241-4.
  34. Bailey A.J., Kent M.J. Non-enzymatic glycosylation of fibrous and basement membrane collagens. Prog. Clin. Biol. Res. 1989; 304(11): 109-22.
  35. Bloodworth J.M., Engerman R.L., Camerini-Dávalos R.A., Powers K.L. Variations in capillary basement membrane width produced by aging and diabetes mellitus. Adv. Metab. Disord. 1970; 1(1): 279.
  36. Steven P., Le Blanc C., Velten K., Lankenau E., Krug M., Oelckers S. et al. Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol. 2013; 131(9): 1135-42.
  37. Liarakos V.S., Ham L., Dapena I., Tong C.M., Quilendrino R., Yeh R.Y. et al. Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens. J. Cataract Refract. Surg. 2013; 39(12): 1835-45.
  38. Tannan A., Vo R.C., Chen J.L., Yu F., Deng S.X., Aldave A.J. Comparison of ACIOL retention with IOL exchange in patients undergoing descemet stripping automated endothelial keratoplasty. Cornea. 2015; 34(9): 1030-4.
  39. Hsu M., Jorgensen A.J, Moshirfar M., Mifflin M. Management and outcomes of descemet stripping automated endothelial keratoplasty with intraocular lens exchange, aphakia, and anterior chamber intraocular lens. Cornea. 2012; 32(5): 64-8.
  40. Gupta P.K., Bordelon A., Vroman D.T., Afshari N.A, Kim T. Early outcomes of descemet stripping automated endothelial keratoplasty in pseudophakic eyes with anterior chamber intraocular lenses. Am. J. Ophthalmol. 2011; 151(1): 24-8.
  41. Ang M., Li L., Chua D., Wong C., Htoon H.M., Mehta J.S. et al. Descemet's stripping automated endothelial keratoplasty with anterior chamber intraocular lenses: complications and 3-year outcomes. Br. J. Ophthalmol. 2014; 98(10): 1028-32.
  42. Yokogawa H., Sanchez P.J., Mayko Z.M., Straiko M.D., Terry M.A. Astigmatism correction with toric intraocular lenses in descemet membrane endothelial keratoplasty triple procedures. Cornea. 2017; 36(3): 269-74.

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