Eyeworld

EW FEATURE 58 All you need to know about cornea transplants • January 2018 AT A GLANCE • Surgeons suggested using slightly different sizes for donors and recipi- ents when determining graft size. • Using pre-marked tissue with an S-stamp can help surgeons ensure correct orientation of the DMEK tissue. • It may be best to avoid using DMEK in some patients. Patients with prior glaucoma surgery or vitrectomy may be better suited for DSAEK. by Ellen Stodola EyeWorld Senior Staff Writer Surgeons discuss their approach to DMEK to help improve outcomes W hen performing Descemet's mem- brane endothelial keratoplasty (DMEK), there are a number of details for surgeons to pay attention to for a successful surgery. Leejee H. Suh, MD, associate professor of clinical ophthalmology and direc- tor of the Laser Vision Correction Center, Edward S. Harkness Eye Institute, Columbia University, New York, W. Barry Lee, MD, Eye Consultants of Atlanta, and Peter Veldman, MD, assistant professor, residency program director, and vice chair for education, Department of Ophthalmology and Visual Science, ed that overstripping, or placing a graft that is smaller than the area of excised recipient Descemet's mem- brane, reduces the rate of rebubble in DMEK due to the minimization of graft overlap with native Descem- et's membrane. "Because of this, I always remove slightly more De- scemet's membrane than I implant, typically a 7.5 mm graft inside of an 8 mm stripping," he said. "I do adjust the graft size, typically small- er, in special circumstances such as under a failed penetrating kerato- plasty or when replacing a DSAEK as the available recipient graft bed dictates." Dr. Lee uses an 8.5 mm trephine (Katena, Denville, New Jersey) to in- dent the epithelium of the recipient with centration around the pupil. This is stained with trypan blue. "I remove the Descemet's membrane and endothelium under the stained epithelial mark and inject donor Surgical pearls for DMEK A DMEK triple procedure, with cataract extraction, IOL implantation, and DMEK Source: Peter Veldman, MD University of Chicago Medicine & Biological Sciences, shared some of their surgical pearls for DMEK. Matching the donor with recipient size Dr. Suh will usually perform a slight- ly larger descemetorhexis, 8 mm for a 7.75 mm DMEK graft, so there is not much overlap between donor and host. According to Dr. Veldman, it has been conclusively demonstrat- Monthly Pulse All you need to know about cornea transplants EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so readers can see how they compare to our survey. If you would like to join the physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@ eyeworld.org and put "EW Pulse" in the subject line. Which cornea transplant surgery do you perform the most? Penetrating keratoplasty (PKP) Descemet's membrane automated endothelial keratoplasty (DSAEK) Descemet's membrane endothelial keratoplasty (DMEK) Deep anterior lamellar keratoplasty (DALK) Which of the following statements applies to you? I know the difference among DSAEK, ultra-thin DSAEK, and DMEK but do not perform cornea transplant surgery I know the difference among DSAEK, ultra- thin DSAEK, and DMEK and perform cornea transplant surgery I do not know the difference among DSAEK, ultra-thin DSAEK, DMEK, and PDEK

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