Eyeworld

66 | EYEWORLD | OCTOBER 2020 Manual vs. femtosecond DMEK U sing femtosecond DMEK in patients with Fuchs dystrophy may be an opportunity to avoid certain com- plications, according to Nir Sorkin, MD. New study results indicate that graft detachment and rebubble rates were significantly reduced using a femtosecond vs. manual approach. 1 "Graft detachment is the most common complication after DMEK," Dr. Sorkin said, adding that in the literature it averages about 13% but has been reported to go as high as 80% in some settings. Graft detachment with the femtosecond approach in the study was just over 6%, as was the need for rebubbling, compared with a rate of more than 30% using the manual approach, Dr. Sorkin said. Investigators in the retrospective study wanted to explore the applicability of fem- tosecond DMEK to see if it could improve outcomes. Fuchs dystrophy patients who were undergoing cataract extraction in conjunction with either femtosecond or manual DMEK were included. "In order to prevent bias of comorbidities, we excluded people who had a complicated anterior segment or patients with previous keratoplasties, scarring, or any other visually significant comorbidity," Dr. Sorkin said. Weighing complication rates The study indicated that there was no statis- tically significant difference in best spectacle- corrected visual outcomes between the study groups at up to 3 years postoperatively. Detach- ment, rebubbling, and endothelial cell loss rates were a different story. With the femtosecond approach, the rate of significant detachment was 6.25% vs. 35.6% with the manual tech- nique. The rebubbling rate was 6.25% and 33.3% for femtosecond and manual DMEK, respectively. Endothelial cell loss rates at the end of the first year were 26.8% for femtosec- ond DMEK vs. 36.5% for manual DMEK; by 3 years, cell loss was 37% for the femtosecond approach and 47.5% for the manual technique. Dr. Sorkin said lower complication rates are important. In the case of a detachment where air needs to be injected into the anterior chamber of the eye to make the graft attach, by Maxine Lipner Contributing Writer About the doctor Nir Sorkin, MD Cornea Fellow Department of Ophthalmology University of Toronto Toronto, Canada bacterial and fungal infections are the most common causes. In children, nutritional defi- ciency is a cause in the developing world, he said. Indications/contraindications Any scar that affects vision can and should be treated, Dr. Basu said. "The problem is that the burden of blindness due to corneal scarring is highest in the developing world, where both lasers and donor corneal tissue are scarce," he said. "Plus, these treatments need skilled corne- al surgeons, and there are not enough around to treat or follow up with the patients. Patients with transplants need lifelong follow-up, and sometimes corneal grafts fail because of poor postoperative care." Dr. Djalilian added that there may be a contraindication for patients who already have a perforation in the eye, particularly in the cornea. "You don't want the cells going inside the eye," he said. "You want them to stay on the cornea." Dr. Djalilian again stressed the experimen- tal nature of this treatment. "In the U.S. any treatment with MSCs is done only under strict monitoring and regulation by the FDA until its safety/efficacy has been established in well-de- signed clinical trials," he said. Dr. Djalilian also noted that some "stem cell clinics" in the U.S. are offering variations of MSCs (a mixed cell population isolated from a patient's own fat or bone marrow), which they are injecting to different parts of the body. "These clinics are quite often in violation of FDA regulations and unfortunately have led to some devastating complications," he said. "Specifically, there are published reports of patients who went blind from injecting cells into the vitreous for conditions such as macular degeneration." continued from page 64 C RESEARCH HIGHLIGHT ORNEA

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