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  • 1
    Online Resource
    Online Resource
    Graft Detachment Pattern After Descemet Membrane Endothelial Keratoplasty Comparing Air Versus 20% SF6 Tamponade
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Cornea Vol. 37, No. 7 ( 2018-07), p. 834-839
    Details
    In: Cornea, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 7 ( 2018-07), p. 834-839
    Abstract: The change from air to 20% sulfur hexafluoride (SF 6 ) as anterior chamber tamponade for Descemet membrane endothelial keratoplasty (DMEK) significantly reduced the rebubbling rate. Nonetheless, underlying mechanisms are not completely understood. In this study, we investigate the morphology of graft detachments after DMEK depending on the tamponade and its influence on postoperative rebubbling. Methods: In this retrospective analysis of prospective data of 204 consecutive patients who underwent DMEK with 100% air, or 20% SF 6 , we compared the SF 6 group with the air group regarding the number, lateral and axial diameter and localization of detachments, visual acuity (BSCVA), and incidence of rebubbling after 1 week (T1), after 1 (T2), 3 (T3), 6 (T4), and 12 (T5) months postoperatively. Results: The air group showed more detachments at all time points. Detachments in this group were of a larger axial diameter at T1, T4, and T5 and of a larger lateral diameter at T1, T3, T4, and T5 compared with the SF 6 group. Patients receiving SF 6 needed fewer rebubblings at T1 compared with patients receiving air (12.1% vs. 29.1%, P = 0.003), but not at T2 (15.1% vs. 19.1%, P = 0.56). There was no difference in postoperative BSCVA between the groups. Conclusions: Early graft attachment after DMEK, which is improved by the use of SF 6 as anterior chamber tamponade, is important for the overall rebubbling rate and improves wound-healing mechanisms between the graft and recipient cornea. Faster resolving air tamponade is associated with extended detachments especially inferiorly and mid-peripherally, but has no negative effect on the long-term BSCVA.
    Type of Medium: Online Resource
    ISSN: 0277-3740
    URL: Article
    DOI: 10.1097/ICO.0000000000001597
    RVK:
    XA 37258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2045943-9
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  • 2
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    Transferability of an Artificial Intelligence Algorithm Predicting Rebubblings After Descemet Membrane Endothelial Keratoplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Cornea Vol. 42, No. 5 ( 2023-05), p. 544-548
    Details
    In: Cornea, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 5 ( 2023-05), p. 544-548
    Abstract: To develop an artificial intelligence (AI) algorithm enabling corneal surgeons to predict the probability of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) from images obtained using optical coherence tomography (OCT). Methods: Anterior segment OCT data of patients undergoing DMEK by 2 different DMEK surgeons (C.C. and B.B.; University of Cologne, Cologne, Germany) were extracted from the prospective Cologne DMEK database. An AI algorithm was trained by using a data set of C.C. to detect graft detachments and predict the probability of a rebubbling. The architecture of the AI model used in this study was called EfficientNet. This algorithm was applied to OCT scans of patients, which were operated by B.B. The transferability of this algorithm was analyzed to predict a rebubbling after DMEK. Results: The algorithm reached an area under the curve of 0.875 (95% confidence interval: 0.880–0.929). The cutoff value based on the Youden index was 0.214, and the sensitivity and specificity for this value were 78.9% (67.6%–87.7%) and 78.6% (69.5%–86.1%). Conclusions: The development of AI algorithms allows good transferability to other surgeons reaching a high accuracy in predicting rebubbling after DMEK based on OCT image data.
    Type of Medium: Online Resource
    ISSN: 0277-3740
    URL: Article
    DOI: 10.1097/ICO.0000000000003049
    RVK:
    XA 37258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2045943-9
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  • 3
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    Online Resource
    Blut-Kammerwasser-Schranken-Störungen bei perforierender und posteriorer lamellärer Keratoplastik: Implikationen für das klinische Ergebnis
    Georg Thieme Verlag KG ; 2023
    In:  Klinische Monatsblätter für Augenheilkunde Vol. 240, No. 05 ( 2023-05), p. 677-682
    Details
    In: Klinische Monatsblätter für Augenheilkunde, Georg Thieme Verlag KG, Vol. 240, No. 05 ( 2023-05), p. 677-682
    Abstract: Background The blood-aqueous barrier (BAB) separates immunoprivileged tissue of the eye from the blood circulation. Disruption of the BAB is therefore a risk factor for rejection after keratoplasty. Purpose The present work provides a review of the work of our group and others on BAB disruption in penetrating and posterior lamellar keratoplasty and its implications for clinical outcome. Methods A PubMed literature search was performed to generate a review paper. Results Laser flare photometry provides an objective and reproducible method to assess the integrity of the BAB. Studies of the flare after penetrating and posterior lamellar keratoplasty demonstrate a mostly regressive disruption of the BAB in the postoperative course, which is influenced in extent and duration by multiple factors. Persistently elevated flare values or an increase in flare after initial postoperative regeneration may indicate an increased risk of rejection. Discussion In case of persistent or recurrent elevated flare values after keratoplasty, intensified (local) immunosuppression may potentially be useful. This could become important in the future, especially for the monitoring of patients after high-risk keratoplasty. Whether an increase of the laser flare is a reliable early indicator of an impending immune reaction after penetrating or posterior lamellar keratoplasty has to be shown in prospective studies.
    Type of Medium: Online Resource
    ISSN: 0023-2165 , 1439-3999
    URL: Article
    DOI: 10.1055/a-2076-7829
    RVK:
    XA 10000
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2039754-9
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  • 4
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    Online Resource
    Corneal Densitometry as a Predictive Diagnostic Tool for Visual Acuity Results After Descemet Membrane Endothelial Keratoplasty
    Elsevier BV ; 2019
    In:  American Journal of Ophthalmology Vol. 198 ( 2019-02), p. 124-129
    Details
    In: American Journal of Ophthalmology, Elsevier BV, Vol. 198 ( 2019-02), p. 124-129
    Type of Medium: Online Resource
    ISSN: 0002-9394
    URL: Article
    DOI: 10.1016/j.ajo.2018.10.002
    RVK:
    XA 19500
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2019600-3
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  • 5
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    Impact of Early Intraocular Pressure Elevation on Postoperative Outcomes After Descemet Membrane Endothelial Keratoplasty in Non-glaucoma Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Cornea Vol. 41, No. 1 ( 2022-01), p. 83-88
    Details
    In: Cornea, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 1 ( 2022-01), p. 83-88
    Abstract: The purpose of this study was to investigate the impact of transient elevations in postoperative intraocular pressure (IOP) on the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) surgery in non-glaucoma patients. Methods: Retrospective analysis from a prospective database of eyes without preexisting glaucoma that underwent DMEK with 90% anterior chamber and 20% sulfur hexafluoride endotamponade. Group A included eyes without postoperative IOP increase (IOP 〈 30 mm Hg and a relative increase from preoperative value 〈 10 mm Hg). Group B included eyes with IOP elevation (postoperative IOP ≥30 mm Hg or a relative increase from preoperative value ≥10 mm Hg) handled according to a standardized protocol. The impact of elevated IOP within 3 days after DMEK surgery was evaluated regarding best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) at 1, 3, and 6 months. Results: One hundred seventy-six eyes from 164 patients were included. An IOP increase after DMEK occurred in 20 eyes (11.3%; 19 patients, group B), and the mean peak IOP was 48 ± 12 mm Hg (range 32–69 mm Hg). There were no significant postoperative differences in BCVA, CCT, and ECC on comparing both groups. The BCVA increased significantly ( P 〈 0.001, respectively), whereas CCT ( P 〈 0.001, respectively) and ECC ( P 〈 0.001, respectively) decreased significantly from preoperative values. The rebubbling rate tended to be higher in group B without statistical significance (6.4% vs. 10%, P = 0.648). Conclusions: Temporary IOP elevation after DMEK may not affect functional and morphological outcomes in non-glaucoma patients. However, careful postoperative IOP monitoring and appropriate management are crucial to avoid irreversible ocular damage.
    Type of Medium: Online Resource
    ISSN: 0277-3740
    URL: Article
    DOI: 10.1097/ICO.0000000000002778
    RVK:
    XA 37258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2045943-9
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  • 6
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    Effect of Anticoagulant Therapy on the Outcome of Descemet Membrane Endothelial Keratoplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Cornea Vol. 40, No. 9 ( 2021-09), p. 1147-1151
    Details
    In: Cornea, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 9 ( 2021-09), p. 1147-1151
    Abstract: To analyze the effect of anticoagulant therapy (ACT) for systemic diseases on the outcome of Descemet membrane endothelial keratoplasty (DMEK). Methods: Consecutive eyes with Fuchs endothelial dystrophy that underwent DMEK between August 4, 2011, and July 15, 2016, were retrospectively analyzed. Data were obtained from the Cologne DMEK database at the University of Cologne, Germany. Best spectacle-corrected visual acuity (logMAR), endothelial cell density (at baseline and postoperatively up to 12 months), and rebubbling rates were compared between patients receiving ACT (ACT group) and those with no anticoagulant treatment (NCT group). Results: In this study, 329 eyes of 329 patients were included (ACT group n = 97, NCT group n = 232; mean age 69.9 ± 9.1 years). Bleeding was more common in the ACT group ( P 〈 0.001). Preoperative best spectacle-corrected visual acuity was 0.59 ± 0.44 and 0.48 ± 0.35 logMAR for the ACT and NCT groups, respectively, which improved to 0.13 ± 0.08 and 0.08 ± 0.16 logMAR, respectively, at 12 months postoperatively. No significant difference in endothelial cell density loss at 12 months was found between the groups (ACT group 36.2% ± 14.7%, NCT group 38.5% ± 15.1%; P = 0.467). Rebubbling rate was 19.6% in the ACT group and 28.9% in the NCT group ( P = 0.08). Conclusions: Although ACT increases the risk for preoperative and intraoperative bleeding in DMEK, there seems to be no negative effect on DMEK outcome. Thus, it is not advisable to stop ACT for DMEK surgery.
    Type of Medium: Online Resource
    ISSN: 0277-3740
    URL: Article
    DOI: 10.1097/ICO.0000000000002533
    RVK:
    XA 37258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2045943-9
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  • 7
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    Descemet Membrane Endothelial Keratoplasty in Vascularized Eyes: Outcome and Effect on Corneal Neovascularization
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Cornea Vol. 40, No. 6 ( 2021-06), p. 685-689
    Details
    In: Cornea, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 6 ( 2021-06), p. 685-689
    Abstract: To report the outcomes after Descemet membrane endothelial keratoplasty (DMEK) in vascularized eyes. Methods: Consecutive cases of DMEK in vascularized eyes (involving ≥2 vascularized quadrants) were selected from a prospective database. Best corrected visual acuity, endothelial cell density (ECD), central corneal thickness, corneal transplant rejection episode, graft survival, and area of neovascularization (quantified using image analysis software) were evaluated. Results: In this study, 24 eyes of 24 patients were selected [mean age, 65.0 years; mean follow-up duration, 14.8 months (6–36 months)], which consists of 14 vascularized eyes after failed penetrating keratoplasty and 10 vascularized eyes with bullous keratopathy. Best corrected visual acuity improved from 1.60 ± 1.02 LogMAR preoperatively to 0.47 ± 0.37 LogMAR 12 months postoperatively ( P 〈 0.001). Central corneal thickness decreased from 824 ± 193 μm preoperatively to 544 ± 48 μm 12 months postoperatively ( P = 0.001). The donor ECD decreased from 2272 ± 723 cells/mm 2 preoperatively to 1570 ± 279 cells/mm 2 12 months postoperatively. The total loss of ECD at the last visit was 40.7% ± 13.0%. Eight of 24 eyes (33.3%) required rebubbling, which resulted in final attachment. The corneal neovascularization area significantly regressed from 4.68% ± 3.26% preoperatively to 2.28% ± 1.58% (n = 18, P = 0.021). Corneal transplant rejection episodes occurred in 1 eye of 24 patients (4.2%). There was no primary graft failure. Conclusions: DMEK is a feasible option to treat endothelial dysfunction in vascularized eyes.
    Type of Medium: Online Resource
    ISSN: 0277-3740
    URL: Article
    DOI: 10.1097/ICO.0000000000002502
    RVK:
    XA 37258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2045943-9
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  • 8
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    Online Resource
    Evolution of Consecutive Descemet Membrane Endothelial Keratoplasty Outcomes Throughout a 5-Year Period Performed by Two Experienced Surgeons
    Elsevier BV ; 2018
    In:  American Journal of Ophthalmology Vol. 190 ( 2018-06), p. 171-178
    Details
    In: American Journal of Ophthalmology, Elsevier BV, Vol. 190 ( 2018-06), p. 171-178
    Type of Medium: Online Resource
    ISSN: 0002-9394
    URL: Article
    DOI: 10.1016/j.ajo.2018.03.036
    RVK:
    XA 19500
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2019600-3
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  • 9
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    Long‐term outcome of descemet membrane endothelial keratoplasty (DMEK) following failed penetrating keratoplasty (PK)
    Wiley ; 2020
    In:  Acta Ophthalmologica Vol. 98, No. 7 ( 2020-11)
    Details
    In: Acta Ophthalmologica, Wiley, Vol. 98, No. 7 ( 2020-11)
    Abstract: To assess the long‐term outcome of Descemet membrane endothelial keratoplasty (DMEK) following failed penetrating keratoplasty (PK). Methods Retrospective review of 1840 consecutive DMEK surgeries from the prospective Cologne DMEK database performed between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne. Results Fifty‐two eyes received a DMEK surgery after failed PK. Main indications for initial PK were Fuchs endothelial corneal dystrophy (23.1%), keratoconus and herpetic keratitis (each 15.4%). Best‐corrected visual acuity (BCVA) at 3, 6 and 12 months was 0.72 ± 0.39 ( n  = 33), 0.56 ± 0.36 ( n  = 32) and 0.38 ± 0.28 ( n  = 23), respectively. Two‐ and 3‐year BCVA was 0.37 ± 0.21 ( n  = 21) and 0.32 ± 0.18 ( n  = 10). Mean improvement in visual outcome in logMAR lines was +4.3 ± 3.4 at 6 months, +5.0 ± 3.6 at 12 months, +6.0 ± 2.3 at 24 months and +5.4 ± 2.7 at 36 months, respectively. 59.6% received at least one rebubbling and 40.4% did not necessitate a rebubbling. Endothelial cell density (ECD)‐decrease at 6 months was 36% ( n  = 17), 37% at 12 months ( n  = 17), 40% at 2 years ( n  = 8) and 32% at 3 years ( n  = 2). 34.6% of transplants needed a regraft. Conclusion Descemet membrane endothelial keratoplasty (DMEK) is a feasible treatment option after failed PK having a relatively good long‐term outcome.
    Type of Medium: Online Resource
    ISSN: 1755-375X , 1755-3768
    URL: Issue
    URL: Article
    DOI: 10.1111/aos.v98.7
    DOI: 10.1111/aos.14417
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2466981-7
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  • 10
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    Online Resource
    Influence of Descemet Membrane Endothelial Keratoplasty Graft Preparation Patterns on Postoperative Clinical Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Cornea Vol. 42, No. 8 ( 2023-08), p. 940-945
    Details
    In: Cornea, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 8 ( 2023-08), p. 940-945
    Abstract: The aim of this study was to quantify preparation difficulties and complications during DMEK graft preparation and their influence on clinical outcome. Methods: A retrospective evaluation of 214 consecutive DMEK surgeries from the prospective Cologne DMEK database was performed between July 2018 and December 2019. Preparation conditions (such as central and peripheral adherences, tissue fragility, and Descemet membrane splitting) were quantified and divided into 3 groups: easy, difficult, and very difficult preparation. At follow-up (3, 6, and 12 months after DMEK), best spectacle-corrected visual acuity, endothelial cell count (ECC), and rebubbling rates were evaluated and compared between groups. Results: An easy preparation was possible in 41.6% of cases (group 1, n = 89), a difficult preparation of the DMEK graft occurred in 30.8% (group 2, n = 66), and a very difficult preparation occurred in 27.6% (group 3, n = 59). There was no difference between groups for best spectacle-corrected visual acuity at 3, 6, and 12 months ( P = 0.179, P = 0.325, and P = 0.682, respectively) or for ECC at 3 and 6 months ( P = 0.537 and P = 0.606, respectively). Only at 12 months, the ECC was slightly significant between groups ( P = 0.045). Regarding the rebubbling rate, there was no difference ( P = 0.585). 17.9% of eyes from group 1, 25.7% of eyes from group 2, and 23.7% of eyes from group 3 received at least 1 rebubbling. Conclusions: These data suggest that difficult preparation conditions do not lead to any worsening of visual acuity or rebubbling rate in the 1-year outcome after DMEK. The endothelial cell density at 12 months showed slightly poorer results in the cases of very difficult preparation.
    Type of Medium: Online Resource
    ISSN: 0277-3740
    URL: Article
    DOI: 10.1097/ICO.0000000000003141
    RVK:
    XA 37258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2045943-9
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