Journal article
The S-stamp in Descemet Membrane Endothelial Keratoplasty Safely Eliminates Upside-down Graft Implantation
Ophthalmology (Rochester, Minn.), Vol.123(1), pp.161-164
01/2016
DOI: 10.1016/j.ophtha.2015.08.044
PMID: 26439215
Abstract
To present 6-month clinical outcomes from a series of 165 consecutive Descemet membrane endothelial keratoplasty (DMEK) procedures before and after the introduction of a novel stromal-sided S-stamp preparation technique that has decreased the incidence of iatrogenic primary graft failure by eliminating upside-down grafts.
Retrospective nonrandomized comparative case series.
We included 165 consecutive eyes that had undergone DMEK surgery for Fuchs' or pseudophakic bullous keratopathy. These cases were divided into 2 cohorts: the first cohort comprised 31 cases that used unstamped tissue before the S-stamp was introduced, and the second cohort comprised 133 cases after the S-stamp was incorporated into the standardized technique. A single unstamped DMEK case was performed after the introduction of the S-stamp for a total of 32 unstamped cases.
Donor materials were prepared at a single eye bank using a standardized technique, which subsequently incorporated the addition of a dry ink gentian violet S-stamp to the stromal side of Descemet membrane. All surgeries were performed at a single clinical site by 5 surgeons (2 attending surgeons and 3 fellows). Two of the 165 DMEK cases were performed for pseudophakic bullous keratopathy (2 cases, 1 in each cohort), and the remaining cases were for Fuchs' endothelial dystrophy. Primary outcome measures were assessed at 6 months and maintained in a prospective institutional review board-approved study.
We analyzed the 6-month endothelial cell density, incidence of iatrogenic primary graft failure, upside-down graft implantation, and rebubble events.
The S-stamp eliminated upside-down graft implantations (0/133 S-stamped vs 3/32 unstamped) and did not significantly alter 6-month endothelial cell loss (31±17% S-stamped vs 29±14% unstamped; P = 0.62) or frequency of rebubble (17/133 S-stamped vs 1/32 unstamped; P = 0.20).
The incorporation of a stromal-sided S-stamp eliminates iatrogenic primary graft failure owing to upside-down implantation of DMEK grafts, without adversely affecting early postoperative complications or 6-month endothelial cell loss.
Details
- Title: Subtitle
- The S-stamp in Descemet Membrane Endothelial Keratoplasty Safely Eliminates Upside-down Graft Implantation
- Creators
- Peter B Veldman - Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Devers Eye Institute, Portland, Oregon. Electronic address: peterbveldman@gmail.comPhilip K Dye - Lions VisionGift, Portland, OregonJeffrey D Holiman - Lions VisionGift, Portland, OregonZachary M Mayko - Lions VisionGift, Portland, OregonChristopher S Sáles - Devers Eye Institute, Portland, OregonMichael D Straiko - Devers Eye Institute, Portland, OregonJoshua D Galloway - Lions VisionGift, Portland, OregonMark A Terry - Devers Eye Institute, Portland, Oregon
- Resource Type
- Journal article
- Publication Details
- Ophthalmology (Rochester, Minn.), Vol.123(1), pp.161-164
- DOI
- 10.1016/j.ophtha.2015.08.044
- PMID
- 26439215
- ISSN
- 0161-6420
- eISSN
- 1549-4713
- Language
- English
- Date published
- 01/2016
- Academic Unit
- Ophthalmology and Visual Sciences
- Record Identifier
- 9984111205902771
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