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32 INTERNATIONAL CONGRESS of the HELLENIC SOCIETY OF INTRAOCULAR IMPLANT
AND REFRACTIVE SURGERY
CORNEA BASIC COURSE
DSAEK to DMEK
Vincenzo Sarnicola, MD
Clinica Degli Occhi Sarnicola, Grosseto
No financial interest to disclose.
Endothelial keratoplasty
DSAEK DMEK
WHY DMEK…
• Better visual acuity(Mark Terry Group) Ophthalmology 2015
• Higher long term ECC (5 years)(Francis Price Group) J. Cataract Refract Surg 2014
• Lower risk of rejection (about 1%)(Francis Price Group) Ophthalmology 2012
• Presumed longer graft survival
SURGICAL TRANSITION from DSAEK to DMEK
Forget about it!!!
“DMEK is a completely different surgery from DSAEK:because graft has different shape and behaviour !!
1. Descemetorexis larger than donor
1. Descemetorexis larger than donor
2014
2015
AVOID OVERLAP between donor and recipient DM!!
✓GRAFT DETACHMET 78%
REBUBBLE RATE 30%GRAFT DETACHMET 33%
REBUBBLE RATE 7%
REBUBBLING & ENDOTHELIAL CELL LOSS
1 air injection = Similar ECL
2 or more air injections = Higher ECL
2. Use pre-stripped tissue
or strip your donor 1 day before surgery
3. Donor catch…
3. Donor catch…make it easier
3. Donor catch…make it easier
4. Secure the main wound
5. Shallow the AC
6. Avoid upside down graft !!!
1. MOUTSOURIS SIGN
2. INTRAOP HANDHELD SLIT BEAM
3. ASIMMETRIC DONOR MARK
MOUTSOURIS SIGN
MOUTSOURIS SIGN ✓
MOUTSOURIS SIGN
MOUTSOURIS SIGN
✓
HANDHELD SLIT BEAM
✓
✓
ASIMMETRIC MARK
ASIMMETRIC MARK
ASIMMETRIK MARK
ASIMMETRIC MARK
7. Use different techniques, every case is different!
TAPPING
TAP TECHNIQUEPhakic eye – Early Onset Fuchs Dystrophy
TAP TECHNIQUEBullous Keratopathy
CANNULA HYDRO-UNFOLDINGwhen DONOR DIAMETER IS TOO LARGE
MECHANICAL UNFOLDINGfor vitrectomized eye
MECHANICAL UNFOLDINGfor vitrectomized eye with AC tube shunt
WET LABS
LIVE PATIENTS EVALUATION
INTERACTIVECLINICAL CASES
SICSSO 2014 in PAESTUM
WET LABsS.I.C.S.S.O. PARTY !!!