Eyeworld

MAR 2020

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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74 | EYEWORLD | MARCH 2020 C SKILL FOCUS ORNEA by Maxine Lipner Senior Contributing Writer Considering thin DSAEK Historically, "standard" DSAEK grafts were 150 µm. In 2009, Edward Holland, MD, pos- tulated that thinner DSAEK grafts resulted in better visual acuity and called DSAEK grafts that were 135 µm or less "thin DSAEK." Mas- simo Busin, MD, developed a technique that re- sulted in DSAEK grafts becoming less than 100 µm and proposed the term "ultrathin DSAEK." Dr. Holland and colleagues developed a tech- nique that resulted in the thinnest grafts to date, "nanothin DSAEK," with the grafts 50 µm or less. A study comparing the nanothin DSAEK technique to DMEK had promising results. 1 "We found that at 1 month the DMEK patients saw better than the nanothin grafts, but at 3, 6, and 12 months, the visual acuity was the same with both techniques," Dr. Holland said. While nanothin DSAEK might cause a slight delay in visual recovery, the graft is easier to handle and unfold, and the detachment rate is lower than DMEK, Dr. Holland said. While DMEK is his preferred procedure for the majority of patients, if graft detachment is more likely or if the patient doesn't have 20/20 potential, Dr. Holland favors nanothin DSAEK over DMEK because of the lower complication rate. E ndothelial transplants continue to evolve, with DSAEK grafts getting thinner and a new, graft-free option, Descemet's stripping only (DSO), be- ginning to emerge. EyeWorld spoke with experts about the latest techniques as well as tried and true procedures. "The current standard of care remains DSAEK by numbers, although DMEK is probably going to become the predomi- nant procedure in the next couple of years because it is growing so quickly," said Mark A. Terry, MD. With DSAEK results improving, the decision of which proce- dure to perform comes down to whether the better vision with DMEK is worth the technique's increased risk of graft failure in complex cases, he said. Dr. Terry thinks that in routine cases, like Fuchs dystrophy, DMEK is the best option, due to faster visual rehabilitation and better quality of vision. But in more challenging cases, such as aphakia or in the presence of an anterior chamber lens, DMEK risk is greater. "If the surgical risk does not warrant the benefit, you should go with the safer procedure," Dr. Terry said. Endothelial transplants on the cutting edge About the doctors Deepinder K. Dhaliwal, MD Professor of ophthalmology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Edward Holland, MD Professor of ophthalmology University of Cincinnati Cincinnati, Ohio Mark A. Terry, MD Director of Corneal Services Devers Eye Institute Portland, Oregon What was once considered very thin for DSAEK at 100 μm is now surpassed by nanothin DSAEK with tissue of 50 μm or less. Source: Edward Holland, MD

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