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Descemet’s Stripping Automated Endothelial Keratoplasty: Different Strokes
Rasik B Vajpayee, Namrata Sharma, Vishal Jhanji, Dermot Cassidy
SECTION 1: EVOLUTION, INDICATIONS, PREOPERATIVE EVALUATION AND EYE BANKING
1:
Evolution of Endothelial Keratoplasty
2:
Indications and Contraindications of Descemet's Stripping Automated Endothelial Keratoplasty
INDICATIONS FOR DSAEK
Fuchs’ Endothelial Dystrophy
Pseudophakic Bullous Keratopathy
Corneal Graft Failure
Irido-Corneal-Endothelial Syndrome
Congenital Hereditary Endothelial Dystrophy
Posterior Polymorphous Dystrophy
Viral Endotheliitis
PRECAUTIONS AND SPECIAL CONSIDERATIONS FOR DSAEK
Anterior Chamber Intraocular Lens
Pre-existing Glaucoma Surgery
Aphakic Bullous Keratopathy
Shallow Anterior Chamber
Anterior Segment Abnormalities and Extensive Peripheral Anterior Synechiae
Pediatric Eyes
CONTRAINDICATIONS TO DSAEK
Stromal Scarring or Opacity
High or Irregular Corneal Astigmatism
Poor Visual Potential
CONCLUSION
3:
Preoperative Evaluation of Descemet's Stripping Automated Endothelial Keratoplasty
HISTORY
EXAMINATION
Ocular Examination
Visual Acuity
Refraction
Eyelids
Conjunctiva and Cornea
ANTERIOR CHAMBER AND IRIS
Intraocular Pressure
LENS
Intraocular Lens Power Calculation
Gonioscopy
Retina
PREOPERATIVE INVESTIGATIONS
Laser Interferometer and Potential Acuity Meter
Visual Evoked Response
Ultrasound
Keratometry
Pachymetry
Corneal Topography
Anterior Segment Optical Coherance Tomography
Ultrasound Biomicroscopy
Specular Microscopy
Confocal Microscopy
4:
Eye Banking Issues Related to Procurement of Donor Cornea
INTRODUCTION
HARVESTING OF DONOR TISSUE
THE IMPACT OF DESCEMET'S STRIPPING ENDOTHELIAL KERATOPLASTY
Modules of Donor Lenticule Preparation-Surgeon Prepared vs Precut Tissue
Femtosecond-Assisted Lenticule Preparation
Tissue Storage
CONCLUSION
SECTION 2: SURGICAL TECHNIQUES AND MODIFICATIONS
5:
Instruments
DONOR PREPARATION
Donor Dissection
Manual Donor Dissection
Automated Microkeratome Donor Dissection
Femtosecond Laser Donor Dissection
Donor Trephination
Donor Lenticule Diameter
RECIPIENT PREPARATION
Surgical Incision and Size
Instruments for Making Incision
Descemet's Scoring and Scraping
Donor Insertion
DSEK Graft Forceps and Folding Techniques
The Pull-through Technique
Suture Pull-through
Needle Assisted
Glide
Injection Device
Vacuum-delivery System Injector (VDS)— Ahmed GHOUL Canada
“Endoshield” —Yichieh SHIVEY
“IDEEL” Injector—Terry O’Brien (Bascom Palmer)
“NCI”—Neuisidl Corneal Injector
6:
Manual Dissection Technique of Descemet's Stripping Endothelial Keratoplasty
DSEK: DONOR TISSUE PREREQUISITES
DSEK: RECIPIENT PREOPERATIVE PREPARATION
DSEK: SPECIAL INSTRUMENTATION
DSEK: RECIPIENT VS DONOR DISK DIAMETER
Anesthesia
SURGICAL TECHNIQUE STEP-BY-STEP
Mounting the Sclerocorneal Button on Barron's Artificial Anterior Chamber5
Donor Lamellar Tissue Preparation
Recipient Bed Preparation
Transplantation of Donor Lenticule
POSTOPERATIVE MANAGEMENT
SPECIAL TIPS FOR SUCCESS
7:
Descemet's Stripping Automated Endothelial Keratoplasty
INTRODUCTION AND BACKGROUND
EVOLUTION OF ENDOTHELIAL KERATOPLASTY
INDICATIONS
Instrumentation
Instruments for Donor Preparation
Instruments for Recipient Preparation
Instruments for Graft Insertion and Positioning
Surgical Technique
Manual Donor Dissection
Microkeratome Donor Dissection
Recipient Preparation
Graft Insertion and Attachment
Combined Procedures
Postoperative Care and Complications
Outcomes
Refractive Outcomes
Visual Outcomes
FUTURE DIRECTIONS
CONCLUSION
8:
Descemet's Stripping Automated Endothelial Keratoplasty: Technique and Insights
INTRODUCTION
SURGICAL TECHNIQUE
Anesthesia
Preoperative Medications
Descemet's Stripping Automated Endothelial Keratoplasty: Recipient Peripheral Scraping Technique
Automated Donor Tissue Preparation
Donor Tissue Preparation Using Pre-Cut Tissue
Transplantation of the Donor Tissue
Combined Surgery with DSAEK
COMPLEX CASES FOR DSAEK SURGERY
Glaucoma Eyes with Trabeculectomies and/or Tubes
Descemet's Stripping Automated Endothelial Keratoplasty in Eyes with an Anterior Chamber IOL
Descemet's Stripping Automated Endothelial Keratoplasty for Prior Failed Full Thickness Penetrating Keratoplasty
Postoperative Course
Postoperative Medication Regimen
9:
Descemet's Stripping Automated Endothelial Keratoplasty Using Suture Pull Through Technique for Graft Insertion
INTRODUCTION
EVOLUTION OF ENDOTHELIAL KERATOPLASTY
PREOPERATIVE EVALUATION
Evaluating the Extent of Endothelial Decompensation
ANESTHETIC CONSIDERATIONS
DONOR PREPARATION
Manual Dissection of the Donor
Automated Dissection of Donor
RECIPIENT DISSECTION
DONOR INSERTION
TECHNIQUES FOR CENTRATION OF GRAFT
TECHNIQUES FOR PROMOTING DONOR ADHESION
CURRENT MODIFICATION IN OUR TECHNIQUE
POSTOPERATIVE REGIME AND FOLLOW-UP
CONCLUSION
10:
Hitch Suture Technique in Descemet's Stripping Automated Endothelial Keratoplasty
DONOR TISSUE PREPARATION
RECIPIENT PREPARATION
RESULTS
DISCUSSION
11:
Sutureless Descemet's Stripping Automated Endothelial Keratoplasty Using Busin Glide
INDICATIONS
PREOPERATIVE CONSIDERATIONS
SURGICAL TECHNIQUE
Anesthesia
Preparation of the Patient
Donor Tissue Preparation
Recipient Preparation
Creation of Surgical Wounds
Stripping of Descemet's Membrane
Creation of Stromal Fenestrations
Insertion of the Donor Lenticule Using the Busin's Glide
Centration of the Donor Lenticule
Drainage of the Interface Fluid
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
Intraoperative Complications
Postoperative Complications
SUMMARY
12:
‘Tan EndoGlide’ Technique of Descemet's Stripping Automated Endothelial Keratoplasty
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
Indications
Contraindications
DEVICE DESCRIPTION
SURGICAL PROCEDURE
Preoperative Considerations
Donor Tissue Preparation
Anesthesia
Surgical Technique
Recipient Preparation
Donor Coiling Procedure
Placement of the Glide Introducer (Fig. 4)
EndoGlide Insertion
Graft Pull-through and Positioning
POSTOPERATIVE MANAGEMENT
SPECIAL TIPS FOR SUCCESS
13:
‘Sheet Glide’ Technique of Descemet's Stripping Automated Endothelial Keratoplasty
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
Indications
Contraindications
SURGICAL PROCEDURE
Preoperative Considerations
Donor Tissue Preparation
Anesthesia
Surgical Technique
POSTOPERATIVE MANAGEMENT
SPECIAL TIPS FOR SUCCESS
14:
Descemet's Stripping Automated Endothelial Keratoplasty
INTRODUCTION
SURGICAL PROCEDURE
Preoperative Considerations
Donor Tissue Preparation
Anesthesia
Surgical Procedure
Cartridge-assisted Descemet's Stripping Automated Endothelial Keratoplasty
SPECIAL TIPS FOR SUCCESS
Ensuring Descemet's Membrane is Removed
Ensuring Correct Donor Graft Orientation
Minimizing Corneal Edema
Minimizing Graft Dislocation
Minimizing Endothelial Cell Loss
POSTOPERATIVE MANAGEMENT
Immediate Postoperative Period
Pharmacologic Treatment
Graft Dislocations
15:
Transitioning to or Learning Descemet's Stripping Endothelial Keratoplasty
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
PATIENT SELECTION
SURGICAL PROCEDURE
POSTOPERATIVE INSTRUCTIONS
DISLOCATIONS
SPECIAL TIPS FOR SUCCESS
16:
Ultra-Thin Descemet's Stripping Automated Endothelial Keratoplasty
INTRODUCTION
INDICATIONS
Relative Contraindications
METHODS AND INSTRUCTIONS
Tissue Preparation (Figs 1A to C)
Surgery (Figs 3A to D and 4A to F)
Postoperative Management
Results (Figs 5 and 6)
Refractive Change
Endothelial Cell Loss
Complications
SECTION 3: DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY IN SPECIAL SITUATIONS
17:
Descemet's Stripping Automated Endothelial Keratoplasty Triple Procedure
INTRODUCTION
COMBINED VS SINGLE STAGED PROCEDURE
INDICATIONS
CONSIDERATIONS
Combining DSAEK with Phaco
Intraocular Lens Implantation
Preparation of Donor Lenticule
PRESURGICAL PREPARATION
Anesthesia
Patient Preparation
SURGICAL STEPS
POSTOPERATIVE TREATMENT
Outcomes
DISCUSSION
18:
Descemet's Stripping Automated Endothelial Keratoplasty in Aphakic Eyes
DIFFICULTIES IN APHAKIC EYES
TECHNIQUES FOR IMPROVING DONOR ADHERENCE IN DSAEK IN ABK
DSAEK in Vitrectomized Eye with Aphakia
Simultaneous DSAEK and IOL Implantation
Temporary Anchor Sutures in DSAEK in Aphakic Eyes
Intraoperative and Postoperative Care
SPECIAL CONSIDERATIONS
DSAEK for Traumatic Aniridia and Aphakia
DSAEK in Patient with Large Iridotomy with Aphakia
SUMMARY
19:
Descemet's Stripping Automated Endothelial Keratoplasty in Intraoperative Floppy Iris Syndrome
INTRAOPERATIVE FLOPPY IRIS SYNDROME
DSAEK IN IFIS
Difficulties
Management
MODIFICATION IN TECHNIQUE OF DSAEK IN IFIS
Suture Drag Technique
Hitch Suture Technique
Others
20:
Descemet's Stripping Automated Endothelial Keratoplasty in Glaucomatous Eyes
INTRODUCTION
FACTORS AFFECTING DSEK SURGERY
Peribulbar or Retrobulbar Block
Glaucoma Tube
Pre-existing Iridotomies
Postoperative Measurement of IOP
Visual Prognosis
Outcomes of DSEK
21:
Descemet's Stripping Automated Endothelial Keratoplasty in Pediatric Eyes
INTRODUCTION
INDICATIONS FOR ENDOTHELIAL KERATOPLASTY IN CHILDREN
Preoperative Assessment of Children Undergoing Endothelial Keratoplasty
Problems Associated with Endothelial Keratoplasty in Children
Postoperative Care
Postoperative Outcomes
EXPERIENCE OF DSEK IN CHILDREN
22:
Descemet's Stripping Automated Endothelial Keratoplasty for Failed Grafts
INTRODUCTION
PENETRATING KERATOPLASTY VERSUS DSEK AS REGRAFT
DSAEK AS REGRAFT
DSAEK as Regraft for Failed Penetrating Keratoplasty
DSAEK as Regraft without Descemet's Stripping
DSAEK as Regraft with Descemet's Stripping
Size of Donor Lenticule
Repeat DSAEK after Failed Primary DSAEK
CONCLUSION
SECTION 4: OUTCOMES AND COMPLICATIONS IN DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY
23:
Outcomes of Descemet's Stripping Automated Endothelial Keratoplasty
GRAFT SURVIVAL
Graft Clarity
Primary Graft Failure
Secondary Graft Failure
VISUAL ACUITY
REFRACTIVE OUTCOME
Hyperopia
Astigmatism
Higher Order Aberration
24:
Intraoperative Complications in Descemet's Stripping Automated Endothelial Keratoplasty
25:
Postoperative Complications
ENDOTHELIAL CELL LOSS
DONOR DETACHMENT AND DISLOCATION
GRAFT REJECTION
PRIMARY GRAFT FAILURE
RAISED INTRAOCULAR PRESSURE AND GLAUCOMA
EPITHELIAL INGROWTH
INFECTIOUS KERATITIS
INTERFACE HAZE
SECTION 5: FUTURE OF ENDOTHELIAL KERATOPLASTY
26:
Descemet's Membrane Endothelial Keratoplasty
27:
Future of Endothelial Keratoplasty
INDEX
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