53
EW FEATURE
December 2016 • Highlights from ESCRS 2016
Editors' note: Dr. Nuijts has financial
interests with Gebauer (Neuhausen,
Germany). Dr. Tan has financial
interests with Network Medical (North
decompensation, such as Fuchs'
dystrophy, with no accompanying
comorbidities," he said.
Dr. Tan has a modified hybrid
DMEK technique, which is now his
standard DMEK technique. Donor
DM is pre-stripped on a DSAEK
pre-cut donor, and both posterior
stromal lenticule and DM are loaded
into an EndoGlide DSAEK cartridge
in a non-scrolled and correct orien-
tation. Only the DM is pulled into
the AC with DSAEK microforceps,
leaving the stromal lenticule in the
DSAEK cartridge.
"My ideal candidate for DMEK
is a patient with endothelial disease
in the absence of other relevant ocu-
lar comorbidities with the exclusion
of senile cataract," Dr. Fontana said.
"Patients with Fuchs' dystrophy are
the ideal candidates for DMEK, com-
bined or not with standard cataract
surgery." These patients often retain
a clear stroma and may benefit most
from a procedure that provides
pristine graft-host interface and
corneal clarity, he said, which allows
for maximum visual acuity. Patients
with previous glaucoma surgery,
an AC IOL implant, or a PC IOL
implant without capsular support
are not good candidates for DMEK,
Dr. Fontana said, but they are still el-
igible for DSAEK. "In these patients,
the air bubble in the AC may remain
in place for an insufficient amount
of time to ensure graft adhesion,"
he said. "However, DSAEK in these
patient may be carried out safely
and with good probability of graft
adhesion."
Future trends
There has been interest among some
surgeons in an endothelial kerato-
plasty procedure called PDEK, Dr.
Hannush said. In this procedure, the
endothelium, Descemet's mem-
brane, and a thin layer of posterior
stroma (15–20 microns) are harvest-
ed from the donor cornea using a
big bubble technique similar to that
employed in DALK. The hypotheti-
cal advantages include the opportu-
nity to use younger tissue than sur-
geons usually use for DMEK. When
successfully harvested, this tissue is
easier to handle intraoperatively and
unscrolls in the anterior chamber
more easily than DMEK tissue does,
Dr. Hannush said. EW
Yorkshire, U.K.). Drs. Fontana and
Hannush have no financial interests
related to their comments.
Contact information
Fontana: luifonta@gmail.com
Hannush: sbhannush@gmail.com
Nuijts: rudy.nuijts@mumc.nl
Tan: Donald.Tan.T.H@singhealth.com.sg
