cornea basic course dsaek to dmek - livemedia.gr · cornea basic course dsaek to dmek vincenzo...

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 !!!