Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaPresentation Time: 8:30 AM - 10:15 AMDescemet’s Membrane Endothelial Keratoplasty (DMEK) :Over-stripping the graft bed promotes donor adherenceMichael D. Straiko, Mark A. Terry, Julia Talajic, David Davis-Boozer. Ophthalmology, Devers Eye Institute, Portland, OR.Purpose: It has been previously reported that avoiding overlap of thedonor DMEK graft with the host Descemet’s membrane (DM) maypromote graft adherence. Based on this suggestion, we altered oursurgical technique and analyzed our results for a difference in the rateof re-bubbling procedures and primary graft failure (PGF).Methods: This study is a retrospective review of a non-randomizedsurgical intervention. 52 DMEK cases were performed for Fuchs’dystrophy eyes. 28 eyes were identified where the host was strippedsmaller than the graft resulting in overlap of the graft and the hostDM. 24 eyes were identified where the host was purposely strippedwider than the size of the graft to avoid overlap of the DMEK graftand host DM. The incidence of graft replacement and frequency ofre-bubbling was compared between the 2 groups.Results: 15 of 28 (53.5%) grafts that overlapped with the host DMrequired rebubbling. This is significantly more than the 6/24 (25%)grafts without overlap of the host DM that required rebubbling(p=0.036). There was no significant difference in the rate of PGF.There was a 10.7% PGF rate for the overlap group and 8.3% for thenon-overlap group (p=1.0).Conclusions: Avoiding overlap of the DMEK graft with the host DMappears to promote adherence of the graft and decrease the rate ofrebubbling procedures. A prospective, randomized study with agreater sample size would be advantageous to further validate thisfinding.Commercial Relationships: Michael D. Straiko, None; Mark A.Terry, Bausch and Lomb Surgical (R), Alcon (R), Optovue (C);Julia Talajic, None; David Davis-Boozer, NoneProgram Number: 3080 Poster Board Number: D0015Presentation Time: 8:30 AM - 10:15 AMPachymetry Assisted Lamellar Keratoplasty for Corneal EctasiaJulio C. Hernandez-Camarena 1 , Victor M. Boullosa 1 , AlejandroNavas 1 , Arturo J. Ramirez-Miranda 1 , Cesar Carriazo 2 , Enrique O.Graue-Hernández 1 . 1 Cornea and Refractive Surgery, Instituto deOftalmología "Conde de Valenciana", Mexico City, Mexico;2 Anterior Segment and Refractive Surgery, Carriazo ScientificOrganization, Barranquilla, Colombia.Purpose: To evaluate the structural, refractive and visual outcomesof pachymetry assisted lamellar keratoplasty in patients with cornealectasia.Methods: Prospective, non-randomized consecutive case series.Patients with corneal ectasia who underwent unilateral surgery usingcustom pachymetry assisted lamellar keratoplasty (PALK) wereevaluated. Host corneas were treated using transepithelial excimerlaser ablation planned to leave 100µm of stromal residual bed. Donorcornea endothelium and Descemet membrane were removedmechanically and then secured to the host cornea with 16 interrupted10-0 nylon sutures. Eyes were examined preoperatively, day 1, month1, 3, 6 and 12 postoperatively. Outcome measures were correcteddistance visual acuity (CDVA), manifest and keratometric refraction,endothelial rejection episodes, conversion to penetrating keratoplasty(PKP), corneal thickness and endothelial cell density (ECD).Results: Five patients with keratoconus grade III and IV (Amsler-Krumeich) and one patient with post-LASIK ectasia were treatedwith PALK. Average follow up was 3.8 months. The meanpostoperative CDVA was LogMAR 0.44 (±0.37)(p=0.02). The meanpostoperative manifest spherical equivalent was -3.00±1.01 (p=0.01)and the mean postoperative keratometric reading was 41.51±2.60(p=0.01). Postoperative central corneal thickness improved to689.16±29.64 (p