Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaDescemet’s Stripping Automated Endothelial Keratoplasty(DSAEK) vs Ultra-Thin DSAEK (UT-DSAEK) vs Descemet’sMembrane Endothelial Keratoplasty (DMEK)Peng Yan, Salina Teja, Kashif Baig. Ophthalmology, University ofOttawa - Eye Institute, Ottawa, ON, Canada.Purpose: To compare the surgical and visual outcomes betweenDSAEK, UT-DSAEK and DMEK as treatments for Fuch’sEndothelial Dystrophy (FED) and Pseudophakic Bullous Keratopathy(PBK).Methods: The first ten consecutive DSAEK, UT-DSAEK, andDMEK patients with either FED or PBK were reviewedretrospectively. In DSAEK, a 350um head was used for all singlepassdissections. In UT-DSAEK, donor corneas were prepared by atwo-pass microkeratome dissection. In DMEK, a trephine-peeltechnique was used to prepare the graft. Data was collected frombaseline up to 6-months follow-up, and outcomes includingintraoperative and postoperative complications, visual rehabilitation,endothelial cell density and follow-up graft thickness were compared.Results: The average age was 76, 69, and 67.5 years for DSAEK,UT-DSAEK, and DMEK respectively. All patients had previouscataract extraction and intraocular lens placement, with an equalnumber of FED and PBK presentations. Mean donor endothelial cellcount was 2597 for DSAEK, 2590 for UT-DSAEK group and 2709for DMEK. No donor tissues were lost during tissue preparation. TheDSAEK group had a mean preoperative best-corrected visual acuity(BCVA) of 20/200 with mean intraocular pressure (IOP) of17mmHg. The UT-DSAEK group had a mean preoperative BCVA of20/80 with mean IOP of 13mmHg. The DMEK group had a meanpre-operative BCVA of 20/120 with mean preoperative IOP of14mmHg. One patient in the DMEK group had a large persistentperipheral graft detachment despite 3 re-bubbling attempts andrequired a second DMEK procedure. Six-month outcomes of visualrehabilitation, endothelial cell loss, graft thickness and graft rejectionfor all patients will be available by March 2013.Conclusions: Endothelial Keratoplasty is constantly evolving, withDSAEK currently being the standard of care. Available literature hasshown the benefits of UT-DSAEK and DMEK, including lower ratesof graft rejection, faster and greater visual recovery and comparableendothelial cell loss. The difficulties with tissue preparation however,have resulted in a slower transition to these two procedures. Thiscomparison of outcomes between our first 10 consecutive patientshaving each procedure will shed light on the relative learning curveand encourage corneal surgeons to consider the benefits of providingthese advanced treatments to their patients.Commercial Relationships: Peng Yan, None; Salina Teja, None;Kashif Baig, Bausch and Lomb (F), Allergan (C), Alcon (C)Program Number: 1750Presentation Time: 11:45 AM - 12:00 PMDiamond knife assisted Deep Anterior Lamellar Keratoplasty(Dia-DALK): A new surgical technique for management ofKeratoconusRasik B. Vajpayee, Prafulla K. Maharana, Namrata Sharma. R Pcentre for Ophthalmic Sciences, All India Institute of MedicalSciences, New Delhi, India.Purpose: To evaluate outcomes of our new technique of DALK incases of KeratoconusMethods: DALK was performed in 20 Keratoconic eyes using ourtechnique of Dia-DALK. The technique involved marking the hostcornea with a 8-8.5 mm trephine and performing an intraoperativepachymetry along that mark at about 11 O'Clock. Subsequently,diamond knife set at a depth 40µ less than that of pachymetry readingwas used to make an incision of 2mm at 11 O'Clock position. Thisincision at that depth was then enlarged with the help of curvedVannas scissors circumferentially and a blunt lamellar dissector wasused to dissect and remove the overlying stromal layers radially. A0.25 mm oversized donor button whose descemet membrane hadbeen scrapped off, was sutured on the host bed. Main outcomemeasures analysed were BCVA, keratometry (Km), sphericalequivalent (SEQ) and endothelial cell density.Results: At 6 month the mean residual host thickness was 41.7±13.8µ. The mean log MAR BCVA improved significantly frompreoperative value of 1.847±0.289 to 0.2117±0.061 (p= 0.005).Theaverage Km improved from 66.5±7.5D to 45.1±1.5D (p=0.03). Themean SEQ decreased from -7.8 ±4.6D to -1.23±0.88 D (p=0.007). Asignificant decrease was seen in refractive astigmatism from 5.93±3.06D preoperatively to 3.23 ±1.14D (p=0.037). The meanendothelial cell loss was 5.241+3.6 %. No intraoperative perforationsoccurred in any of the cases.Conclusions: Our technique of Dia-DALK is safe, predictable andeffective for the mangement of Keratoconus. It has the potential tobecome an alternative to Big Bubble DALKCommercial Relationships: Rasik B. Vajpayee, None; Prafulla K.Maharana, None; Namrata Sharma, NoneProgram Number: 1751Presentation Time: 12:00 PM - 12:15 PMFemtosecond Laser-Assisted Deep Anterior LamellarKeratoplasty with Zig-zag Configuration: Initial OutcomesIjeoma Asota, Matthew Wade, John Xie, Sumit Garg, Roger F.Steinert, Marjan Farid. Gavin Herbert Eye Institute, University ofCalifornia Irvine, Irvine, CA.Purpose: To report the early refractive results and clinical outcomesof deep anterior lamellar keratoplasty (DALK) performed using thefemtosecond laser with the zig-zag incision configuration.Methods: 30 consecutive eyes underwent femtosecond laser assistedDALK with zig-zag configuration. Clinical records were reviewedretrospectively. Corrected distance visual acuity (CDVA), manifestand topographic astigmatism, and complications were reviewed.Results: In 26 eyes, a big-bubble was successfully achieved. Theremaining 4 eyes required dissection down to a very thin residualstromal bed. Postoperative follow-up ranged from 3 months (n=28) to2.5 years (n=3). At post-operative month 3, mean CDVA was 20/30(range 20/20-20/60), mean manifest astigmatism was 3.5 D (range1.25-6 D), and mean topographic astigmatism was 4.23 D (range 1.1-9.25 D). These outcomes remained stable throughout the follow upperiod. Complications included suture revision at post-operativemonth 3 for wound gape in one patient, and an episode of stromalrejection in one patient.Conclusions: Visual outcomes of femtosecond laser-assisted zig-zagDALK are similar to our results with zig-zag full thicknesspenetrating keratoplasty. In addition, this technique offers adecreased risk of endothelial rejection in healthy eyes compared topenetrating keratoplasty.Commercial Relationships: Ijeoma Asota, None; Matthew Wade,None; John Xie, None; Sumit Garg, None; Roger F. Steinert,Abbott Medical Optics (C), OptiMedica (C), ReVision Optics (C),WaveTec (C); Marjan Farid, NoneProgram Number: 1752Presentation Time: 12:15 PM - 12:30 PMCorneal Endothelial Cell Loss after Endothelial and PenetratingKeratoplasty for Endothelial DiseaseSanjay V. Patel, Keith H. Baratz, Jay W. McLaren, Lori A. Bachman,William M. Bourne. Ophthalmology, Mayo Clinic, Rochester, MN.©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.