EyeWorld Asia-Pacific March 2014 Issue

43 EWAP CORNEA March 2014 the tissue with air and fluid Once the lenticule is unrolled, an air bubble is injected underneath the donor graft lenticule to lift it toward the recipient posterior stroma. The anterior chamber is completely filled with air for the next 30 minutes, followed by an air-liquid exchange to pressurize the eye The eye speculum is finally removed, and the anterior chamber is examined for air position. The patient is advised to lie in a strictly supine position for the next three hours. Results so far The spectral domain optical coherence tomography evaluation of the grafts shows no interface changes like opacification at one month follow up. PDEK graft harvesting is possible in donors of all age groups. PDEK requires no specialized or expensive equipment. Our short-term results of PDEK are comparable to the visual recovery of DMEK with less chance of interface opacification and graft dislocations. Intraoperative tissue handling seems less challenging due to the thick nature of the graft. The technique requires no additional learning curve. Different from existing endothelial keratoplasties Intraoperative graft unrolling and tissue handling is easier due to the thicker nature of the PDEK graft as compared to DMEK graft. PDEK graft can be harvested from donors of any age without difficulty. The thickness of the PDEK graft is less than conventional Descemet’s stripping automated endothelial keratoplasty (DSAEK) and ultrathin DSAEK. Hence the tissue additive effect seen with PDEK is less than DSAEK. There is less chance of posterior corneal curvature change and therefore less risk of hyperopic shift. PDEK takes ultra thin-DSAEK to a “thinner level” while retaining its advantages but not requiring sophisticated instrumentation and a keratome. In a small pilot study done in our center, in vivo analysis of PDEK grafts showed mean graft thickness after one month to be 28±5.6 µm, which is larger than the conventional DMEK graft and less than the ultra-thin DSAEK graft. Faster visual recovery is obtained after surgery, and unlike DSAEK there is no significant interface haze. Summary • Pre Descemet’s collagen layer can be used to increase the thickness of the endothelium- DM complex for endothelial transplantation to reduce the intraoperative tissue handling problems. • Pre Descemet’s endothelial keratoplasty (PDEK) provides faster visual recovery comparable to conventional Descemet’s membrane endothelial keratoplasty (DMEK). • Unlike DEMEK, PDEK graft can be harvested in donors of all age groups. EWAP Editors’ note: Dr. Agarwal is affiliated with Dr. Agarwal’s Eye Hospital and Eye Research Centre, Chennai, India. He has no financial interests related to this article. Contact information Agarwal: dragarwal@vsnl.com MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com THE MORIA OPTION FOR SBK Make your own comparisons between the One Use- Plus and a femtosecond laser in terms of capital investment, disposables per patient, and annual maintenance. www.moria-surgical.com Think Thin Thin, 100-micron, planar flaps Accuracy and predictability equivalent to Femto-SBK Smoother stromal bed No femto-complications … At a fraction of the cost