Novel liquid bubble dissection technique for DMEK lenticule preparation.

PURPOSE: Descemet endothelial keratoplasty (DMEK) has replaced penetrating keratoplasty in many cases of endothelial cell disorders. While DMEK has been greatly improved by the introduction of no-touch injection cartridges, the tear-free preparation of the delicate Descemet's membrane (DM) remains a critical step. We present a novel liquid bubble dissection technique for DM preparation that could offer several advantages. METHODS: After identification of the iris base, a sharp dissection until Schwalbe's line was performed. Then, a narrow tunnel was created with a blunt spatula using a tangential dissection technique. After the tunnel was created, the liquid bubble dissection was performed. The complete detachment process took only a few seconds after a successful preparation of the tunnel in the correct plane between the DM and corneal stroma. RESULTS: Between February and September 2015, we consecutively performed 86 DMEK lenticule preparations using the liquid bubble technique. The preparation time until complete detachment was about 3 min (mean 194 ± 20 s). Ninety-two percent of preparations were completely uncomplicated; the total success rate was 99 %. One graft could not be used for transplantation because of a central tear. The graft failure rate was 1.16 %, similar to other authors. CONCLUSIONS: The presented novel liquid bubble technique is easy, can be learned and performed rapidly, is highly reproducible in a standardized fashion with minor tissue manipulation (no touch) and, with a low rate of graft preparation failure, necessitates no special equipment and allows for a simultaneous and selective staining of the stromal side of DM, thus avoiding direct contact.

The effect of canaloplasty with suprachoroidal drainage combined with cataract surgery - 1-year results.

PURPOSE: The purpose of this study was to investigate the safety and efficacy of phacocanaloplasty with suprachoroidal drainage (PCscD) and to compare its intraocular pressure (IOP)-lowering and drug-sparing effect to canaloplasty with suprachoroidal drainage (CscD). METHODS: The study retrospective interventional study included patients with open-angle glaucoma or secondary forms of glaucoma who underwent either CscD or PCscD between the year 2011 and 2014 in Knappschaft Eye Clinic Sulzbach. Primary end-points were IOP reduction and the number of IOP-lowering medication after 12 months. Secondary end-points were intraoperative and postoperative complications. RESULTS: A total of 328 eyes were included, 193 were treated with CscD and 135 underwent PCscD. Canaloplasty with scD achieved an IOP reduction of 37.0% (from 20.9 ± 3.6 mmHg to 13.2 ± 2.6 mmHg) after 1 year, whereas PCscD showed a significant higher reduction of 47.4% (from 23.2 ± 5.1 mmHg to 12.2 ± 1.7 mmHg). Reduction in IOP-lowering medication was higher after PCscD (from 3.6 ± 0.6 to 0.2 ± 0.5) than after CscD (from 3.5 ± 0.8 to 0.7 ± 1.0). Twelve months after surgery 55.5% in the CscD group and 80.2% in the PCscD group were free of IOP-lowering medication. In both groups, no severe or sight-threatening complications occurred. CONCLUSION: Combining cataract surgery and CscD achieves a higher IOP reduction, and patients postoperatively need less IOP-lowering medication than after CscD alone.

Clinical Comparison of Two Methods of Graft Preparation in Descemet Membrane Endothelial Keratoplasty.

PURPOSE: Descemet membrane endothelial keratoplasty (DMEK) has been improved over the last decade. The aim of this study was to compare the clinical outcome of the recently introduced liquid bubble method compared to the standard manual preparation. METHODS: This retrospective study evaluated the outcome of 200 patients after DMEK surgery using two different graft preparation techniques. Ninety-six DMEK were prepared by manual dissection and 104 by the novel liquid bubble technique. The mean follow-up time was 13.7 months (SD ± 8, range 6-36 months). RESULTS: Best corrected mean visual acuity (BCVA) increased for all patients statistically significant from baseline 0.85 logMAR (SD ± 0.5) to 0.26 logMAR (SD ± 0.27) at the final follow-up (Wilcoxon, p = 0.001). Subgroup analyses of BCVA at the final follow-up between manual dissection and liquid bubble preparation showed no statistically significant difference (Mann-Whitney U Test, p = 0.64). The mean central corneal thickness was not statistically different (manual dissection: 539 µm, SD ± 68 µm and liquid bubble technique: 534 µm, SD ± 52 µm,) between the two groups (Mann-Whitney U Test, p = 0.64). At the final follow-up, mean endothelial cell count of donor grafts was statistically not significant different at the final follow-up with 1761 cells/mm2 (-30.7%, SD ± 352) for manual dissection compared to liquid bubble technique with 1749 cells/mm2 (-29.9%, SD ± 501) (Mann-Whitney U-Test, p = 0.73). The re-DMEK rate was comparable for manual dissection with 8 cases (8.3%) and 7 cases (6.7%) for liquid bubble dissection (p = 0.69, Chi-Square Test). CONCLUSION: Regarding the clinical outcome, we did not find a statistical significant difference between manual dissection and liquid bubble graft preparation. Both preparation techniques lead to an equivalent clinical outcome after DMEK surgery.

Femtosecond laser-assisted cataract surgery: First clinical results with special regard to central corneal thickness, endothelial cell count, and aqueous flare levels.

PURPOSE: To evaluate clinical data and outcomes after femtosecond laser-assisted cataract surgery with the recently introduced low-energy Femto LDV Z8 laser during a 3-month follow-up. SETTING: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar GmbH, Sulzbach, Germany. DESIGN: Consecutive case series. METHODS: Femtosecond laser-assisted cataract surgery was performed using the low-energy femtosecond laser. Clinical data including objective refraction, corrected distance visual acuity, central corneal thickness (CCT), endothelial cell count (ECC), and aqueous flare were evaluated 1 day, 1 week, 4 weeks, and 3 months postoperatively. RESULTS: The median CCT and aqueous flare were statistically significantly elevated during the first day and 4 weeks after surgery, respectively (P < .001). There were no significant differences between CCT preoperatively and 1 week postoperatively (P = .079) and aqueous flare preoperatively and 3 months postoperatively (P = .082). No statistically significant difference was found in the median ECC and spherical equivalent refraction between preoperatively and postoperatively (P > .05). CONCLUSION: Visual outcomes and investigated parameters reflecting corneal integrity indicated safe and atraumatic surgery using a new low-energy femtosecond laser for laser-assisted cataract surgery (including capsulotomy and lens fragmentation). FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.