EyeWorld India June 2015 Issue

Corneal lamellar surgical procedures June 2015 31 EWAP SECONDARY FEATURE hand, but later on we found that preparing using a microkeratome was the gold standard.” Thinning DSAEK down One new development with DSAEK is that thin, reproducible lenticules can now be prepared, Dr. Busin said. Known as ultra- thin DSAEK, this involves transferring only the endothelium and Descemet’s membrane, he explained. “The results with thin donor tissue are better than with thicker tissue,” he said. The speed of rehabilitation and percentage of patients that achieve 20/20 vision is greater with this approach. Dr. Neff likewise touts outcomes with thinner tissue. “Results have been very good, particularly in thin DSAEK,” she said, adding that a high number attain 20/20 acuity. Not only do patients achieve better vision with thin DSAEK, but some have noticed lower rejection rates as well, Dr. Neff said. In a study that Dr. Neff conducted, which was published in the April 2011 issue of Cornea, investigators found that thinner endothelial keratoplasty resulted in a significant improvement in best spectacle-corrected visual acuity. “We found that there was a statistically significant difference between tissue thicker than 131 µm and thinner in terms of visual outcomes,” Dr. Neff said. She favors tissue that is less than 135 µm thick. However, in general, she is careful about not rejecting tissue solely based on thickness unless there is some other issue with the cut. “If it’s a little thicker, I try to match the tissue to a patient who doesn’t have 20/20 visual potential to use that tissue,” Dr. Neff said. Dr. Shamie prefers using donor tissue under 150 µm. However, if it is slightly thicker, she will not reject it. “I feel a sense of obligation to the donor pool not to reject corneas because that cornea may be wasted,” she said. On the other end of the spectrum, Dr. Shamie does not like tissue that is thinner than 80 µm because this is harder to handle. Still, she recognizes that there can be advantages to using ultra-thin tissue. “There’s some evidence that thinner grafts could potentially lead to faster vision recovery or better visual outcomes,” she said. “But you have to weigh that against increased trauma to the thin graft as you’re manipulating it for graft insertion.” Dr. Busin usually welcomes an extremely thin graft of below 80 µm. As he performs 200 to 300 DSAEKs a year, he prefers to prepare the tissue himself, rather than have it done at the eye bank. This allows him to save a significant amount of money each year. Currently, he finds that the DSAEK approach can successfully serve many patients. “You can treat any patient with decompensated endothelium,” Dr. Busin said, adding that he even selects the procedure for those with bad stroma. “It’s the rare case where the cornea doesn’t clear properly or there are residual scars that interfere,” he said. He still performs DSAEK and may later go on and perform a DALK, leaving the DSAEK in place. “I had several cases where I was undecided whether it would be worth it to do DSAEK or just remove everything and do a PK, and in several instances I’ve seen that doing DSAEK gives an improvement that you would not expect to start with,” he said. “It’s worth it to try DSAEK.” Dr. Shamie finds that any patient with endothelial disease, except for those with severe corneal scarring, can benefit from DSAEK. She typically recommends that patients whose vision drops below 20/40 be referred to a cornea specialist for transplant evaluation, continued on page 39 Corneal lamellar surgical pr cedures June 2015 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