the cornea, transplants and specialized cuts
DESCRIPTION
Gregory Schmidt, BS, CBTE Director of Tissue Preparation and Research, Iowa Lions Eye BankTRANSCRIPT
The Cornea, Transplants and Specialized Cuts
Gregory Schmidt, BS, CEBTDirector of Tissue Preparation and Research
Iowa Lions Eye Bank
Layers of the Cornea
The Endothelium
Single layer of cells\Uniform in shape and density
Acts as a pumping mechanism
Cells do not proliferate Loss of cells results in enlargement/migration of neighboring cells
Trends and changes in eye banking occur to keep up with the advances in surgical techniques.
DSAEK – 2005 (North Carolina Eye Bank)IEK – 2006 (SightLife)DMEK/DMAEK – 2009 (Iowa Lions Eye Bank)
Surgical Trends
Penetrating Keratoplasty
Penetrating Keratoplasty ‐ LAK
Penetrating Keratoplasty – LAK Mushroom
Penetrating Keratoplasty – LAK Tophat
Penetrating Keratoplasty – LAK ZigZag
Amount of time to achieve BVA (3‐12 months) Greater surface area to promote stronger wound healing
Astigmatism
Penetrating Keratoplasty
23,26921,970
21,620 21,422 20,954
18,22119,159
21,55523,049
24,987
1,116 1,5133,021
2,213 2,288
0
5,000
10,000
15,000
20,000
25,000
30,000
2009 2010 2011 2012 2013
EBAA Domestic Transplants by Type5‐year Data 2009‐2013
PKP EK Other
Surgical Trends
Endothelial Keratoplasty (EK)
EK ‐Microkeratome
EK ‐Microkeratome
DSAEK Graft
Visual recovery is shorter (2‐6 weeks) No induced astigmatism Refractive shift Small incision – stronger globe strength
Endothelial Keratoplasty
DMEK Grafts
Fast visual recovery No refractive shift Smaller incision
DMEK Grafts
DMEK ‐Microkeratome
Where the bubble begins – DMEK/DMAEK Surgeon request for DMAEK prepared grafts Surgeon feedback Scrolls were tight
DMEK ‐Microkeratome
FS‐DMAEK
Surgeons shifted the request for DMEK tissue Comfort and improvements with the procedure Increase in request for eye bank prepared tissue
Surgeon Trend
0 1 1
4
9
5 7
5
8
4
10 10 9
11 10
14
17
21
0
5
10
15
20
25
How is the graft prepared? Peeled vs. Big bubble
Surgeon preference What’s best for the eye bank – peeled (91% success rate)
Surgeon Trend
DMEK ‐ Peeled
Images on Slit Lamp
Learning Curve Beyond the manual dexterity
Donor Selection Age Does the donor’s medical history influence outcomes?
No diabetic tissue – 97% success rate Consistency amongst preparation type Customized to the surgeon’s specific request
Designated graft size (8.0mm, 8.5mm, or 9.0mm) Specific peripheral markings – use of the “S” stamp
Better results/Improvements
What are we working on now?
Seahorse
Seahorse
Seahorse
For more information
Greg Schmidt, BS, CEBTIowa Lions Eye BankGregory‐[email protected]
Thank You
Questions?