This thesis focuses on the clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK). Chapter 2 describes the suitability of septic donor corneas for transplantation and the... Show moreThis thesis focuses on the clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK). Chapter 2 describes the suitability of septic donor corneas for transplantation and the clinical outcomes after DMEK using septic versus non-septic donor corneas. Chapter 3 aims to analyze the incidence of cataract extraction in eyes that previously underwent DMEK surgery and the effect of the phacoemulsification procedure on the endothelial cell density (ECD) after DMEK. Chapter 4 of the thesis concentrates on the 6-month ECD after DMEK, as it is one of the benchmark parameters for graft performance. In this chapter, the relation between the ECD 6 months after DMEK and its predictive value for 5-year graft survival in FECD eyes are discussed. Chapter 5 evaluates the 10-year graft survival and clinical outcome results of the first 100 eyes that received DMEK. Chapter 6 presents a larger case series of DMEK eyes where the 10-year clinical outcomes and graft survival after DMEK are analyzed based on the surgical indication of the eye and the preoperative severityof FECD. Show less
Vasiliauskaite, I.; Quilendrino, R.; Baydoun, L.; Dijk, K. van; Melles, G.R.J.; Oellerich, S. 2021
Purpose: To analyze if 6-month endothelial cell density (ECD) affects long-term ECD outcome and graft survival 5 years after Descemet membrane endothelial keratoplasty (DMEK) in eyes with Fuchs... Show morePurpose: To analyze if 6-month endothelial cell density (ECD) affects long-term ECD outcome and graft survival 5 years after Descemet membrane endothelial keratoplasty (DMEK) in eyes with Fuchs endothelial corneal dystrophy (FECD).Design: Retrospective cohort study.Participants: A total of 585 DMEK eyes were included. The study group was divided into 4 groups based on 6-month ECD quartiles: group 1 (n = 146) with 313 to 1245 cells/mm(2), group 2 (n = 148) with 1246 to 1610 cells/mm(2), group 3 (n = 145) with 1611 to 1938 cells/mm(2), and group 4 (n = 146) with 1939 to 2760 cells/mm(2). Group 1 was further split into subgroups 1a (n = 36) with 6-month ECD of <828 cells/mm(2), 1b (n = 37) with 829 to 1023 cells/mm(2), 1c (n = 37) with 1024 to 1140 cells/mm(2), and 1d (n = 36) 1141 to 1245 cells/mm(2).Methods: Descemet membrane endothelial keratoplasty.Main Outcome Measures: Long-term ECD, graft survival, and postoperative complication rates.Results: For group 1, 6-month ECD decreased from 951 (+/- 233) cells/mm(2) (n = 146) to 735 (+/- 216) cells/mm(2) (n = 99) at 5 years postoperatively. Group 1 graft survival probability was 0.95 (95% confidence interval [CI], 0.91-0.99] at 5 years postoperatively, which was lower than for groups 2 to 4 (P = 0.001). Five-year graft survival in subgroup 1a was 0.79 (95% CI, 0.67-0.94), which was lower than in subgroups 1b to 1d (P = 0.001). Preoperative ECD did not influence graft survival (P = 0.400), and higher 6-month ECD values were associated with lower graft failure rates (hazard ratio, 0.994; 95% CI, 0.99-1.00; P = 0.001).Conclusions: Six-month ECD is associated with DMEK graft survival. High early cell loss after DMEK negatively affects long-term ECD outcome and graft survival. Grafts in the lowest 6-month ECD subgroup (<828 cells/mm(2)) are at higher risk of failure within 5 years after DMEK. To ensure sufficiently high 6-month ECD, preoperative graft quality assessment should be optimized, and cellular stress induced to the graft should be minimized. Additionally, developing therapeutic options for the treatment of low postoperative ECD could further improve DMEK graft longevity. (C) 2021 by the American Academy of Ophthalmology Show less
After penetrating keratoplasty had been the preferred method for the treatment of corneal disorders for almost a century, the introduction of lamellar keratoplasty techniques has changed the... Show moreAfter penetrating keratoplasty had been the preferred method for the treatment of corneal disorders for almost a century, the introduction of lamellar keratoplasty techniques has changed the field of corneal transplantation substantially over the last two decades. These lamellar keratoplasty techniques provide several advantages over penetrating keratoplasty: anterior lamellar keratoplasty may potentially improve graft survival by preserving the healthy recipient endothelium in the management of corneal stromal diseases, and endothelial keratoplasty has improved the predictability and speed of visual rehabilitation for treating endothelial disorders, mainly by leaving the anterior corneal surface intact. The latest innovation in the field of endothelial keratoplasty is Descemet membrane endothelial keratoplasty (DMEK), in which only the Descemet membrane and endothelium are replaced by donor tissue. The trend towards more selective and minimally invasive transplantation techniques has also led to the development of new treatment options for patients with (advanced) keratoconus, including the mid-stromal implantation of an isolated donor Bowman layer, referred to as Bowman layer-transplantation. This thesis focusses on the feasibility and clinical outcomes of these two modern lamellar keratoplasty techniques, i.e. DMEK for endothelial disorders, and Bowman layer-transplantation for advanced keratoconus. Show less
Since 1998, various new surgical techniques have been devised for the treatment of diseases of the anterior and posterior cornea; this thesis explores some of these options including Descemet... Show moreSince 1998, various new surgical techniques have been devised for the treatment of diseases of the anterior and posterior cornea; this thesis explores some of these options including Descemet Membrane Endothelial Keratoplasty (DMEK) and Bowman Layer Transplantation. Show less
Dijk, K. van; Rodriguez-Calvo-de-Mora, M.; Esch, H. van; Frank, L.; Dapena, I.; Baydoun, L.; ... ; Melles, G.R.J. 2016
