Evaluation of a New Technique to Increase Usage of Donor Descemet’s Membrane for DMEK World Cornea Congress VII - April 15-17, 2015 Electronic Poster Javiera.

Evaluation of a New Technique to Increase Usage of Donor Descemet’s

Membrane for DMEK

World Cornea Congress VII - April 15-17, 2015 Electronic Poster

Javiera M. Compan, MD; Esteban Santiago, MD; Ronan Conlon, MD; Kashif Baig, MD, MBA, FRCSC

University of Ottawa Eye Institute, Ottawa, Ontario, Canada

Financial Disclosures

Drs. Compan, Santiago, and Conlon have no financial relationships to disclose.

Dr. Baig has the following relationships:

Financial Interest/ Affiliation Name of Company(s)

Grant/Research Support Allergan, Bausch & Lomb, Merck, Moria

Employment/Honoraria/Consulting Fees/Travel Expenses Alcon, Allergan, Bausch & Lomb, Labtician

Major Stock Shareholder None

Member: Advisory Panel, Standing Committee, Board of Directors Allergan, Bausch & Lomb

Other Financial or Material Interest None

Introduction

Donor corneal tissue is a limited resource which may affect wait times. The migratory movement of donor endothelial cells play an important role

following DMEK surgery. Conventional use of corneal tissue: One donor per procedure

Split corneal tissue: Hemi-Descemet membrane endothelial keratoplasty transplantation: a potential method

for increasing the pool of endothelial graft tissue. Lam FC, Baydoun L, Dirisamer M, Lie J, Dapena I, Melles GR. JAMA Ophthalmol. 2014 Dec;132(12):1469-73.

Current Approaches to Combat the Shortage of Corneal Tissues: Split-DMEK and Double-Split Keratoplasty. Yoeruek E1,Bartz Schmidt K. Cornea. 2015 Mar;34(3):e6-9.

Methods Retrospective; case series

Inclusion criteria Pseudophakic patients with endothelial dysfunction undergoing DMEK

Technique A trephine/SCUBA technique was first used to harvest the DMEK graft Each graft was then split in 2 (2 different shapes were used) The 2 halves were used in 2 different patients undergoing DMEK

Tissue preparation and operative use occurred on the same day

Tissue preparation challenges, intraoperative complications, and visual recovery were assessed

Tissue preparation

Two almond-shaped grafts

Two hemi-circle shaped grafts

Original shape

Visit Cornea Ottawa Eye Institute in YouTube to see videos of the surgeries

Results

4 corneoscleral rims were used to prepare tissue for 8 DMEK procedures. Demographics

Mean age: 76 years (range 69-83) Gender: 6 females, 2 males Preoperative diagnoses:

7 - Fuchs Dystrophy 1 - Pseudophakic Bullous Keratopathy (PBK) 1 - Descemet’s membrane detachment (DMD) during cataract surgery

Previous Surgeries: 1 – Ahmed valve 1 - Failed DSAEK (DMD patient)

Surgical Experience

Almond Shape Hemi-circle

Area (mm2) 40 49

Mean donor age (years) 58 68

Peeling difficulty + ++

Intraoperative complications Vitreous loss in one patient Small fold in graft


Results

Almond Shape Hemi-Circle

Number of patients 2 6

Mean patients age (years) 69 78

Pre-operative diagnosis Fuchs dystrophy (2)Fuchs dystrophy (4)

PBK (1) DMD (1)

Post-operative complications Graft detachment (2) Primary graft failure (1)

% of post-operative grafts attached 0% 100%

Success rate 0% 83% (5 patients)

Failure rate 100% 17% (1 patient)

Results

4 donor tissues were used in 8 DMEK procedures 2 almond shape grafts had complete detachments

2 days after surgery and DMEK was repeated using conventional circular donor tissue

6 semi-circle shape grafts attached in post operative period

5 grafts were clear between one and six months follow-up

1 graft suffered primary failure (DMD patient) and DMEK was repeated conventional circular donor tissue

At the last follow-up (between 2 and 4 months), the 5 remaining patients with clear grafts had an improvement in BCVA.

Post-operative visual acuity in successful patients

Preop 1 day 1 week 1 month 2 months 4 months

Patient 1 20/80 20/150 20/150 20/50 20/30 20/30+2

Patient 2 20/70 20/60 20/30 20/30 20/20 -

Patient 3 20/200 20/70 20/70 20/70 20/40 -

Patient 4 20/50 20/250 20/50 20/40 20/20 -

Patient 5 20/100 20/100 20/80 20/60 20/60 -


Conclusions A single donor corneal graft can be used for two DMEK procedures, and is a promising

strategy to improve the efficiency of corneal transplantation.

This technique of splitting DMEK could diminish further use of donor tissue. In this study, all saved donor tissues were used for other patients

Different factors may play a role in the functioning of the graft. Success of Hemi-DMEK depends on graft quality, donor-recipient integration, surgeon

ability for a Descemet stripping and splitting performed without incident and intraoperative graft manipulation among others.

Grafts with sharp edges are apparently more instable and tend to detach.

Five of six hemi-circle shaped grafts remain attached and clear at the end of this chart review, all of them with a visual acuity improvement trend.

A larger number of patients and a long term follow-up is necessary to compare DMEK versus hemi-DMEK in terms of procedure success and safety.

Cornea, Anterior Segment, and Refractive Surgery Teamat the

University of Ottawa Eye Institute

Attendings Kashif Baig, MD, MBA Bruce Jackson, MD George Mintsioulis, MD Setareh Ziai, MDClinical Fellows Samer Abuswider, MD (2009-11) Setareh Ziai, MD (2011-12) Abdulmajeed Aljaethen, MD (2012-13) Season Yeung, MD (2013-14) Joshua Teichman, MD, MPH (2013-14) Javiera Compan (2014-15) Esteban Santiago (2014-15)Research Fellows Mustafa Kapasi, MD (2011-12) Salina Teja, MD (2012-13) Ronan Conlon, MD (2013-14)Technologists Sabrina Taylor, COMT Emily Wong, COMTResearch Melanie Lalonde, PhD Gail Kayuk, BSc, ART Annelise Saunders, LLB

Evaluation of a New Technique to Increase Usage of Donor Descemet’s Membrane for DMEK World Cornea Congress VII - April 15-17, 2015 Electronic Poster Javiera.

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