Eye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty Lenticules.

PURPOSE: To report the management of precut Descemet stripping automated endothelial keratoplasty (DSAEK) lenticules unsuitable for transplantation because of irregular anterior profile after microkeratome cutting. METHODS: After preparation for DSAEK, 20 tissues were considered unsuitable for transplantation because of nonhomogeneous posterior stromal thickness. To convert them into suitable tissues for surgery, manual stromal delamination was performed by removing the excess stromal layers after the indications obtained through optical coherence tomography. These tissues were further transplanted as ultrathin DSAEK. RESULTS: Nineteen tissues were delaminated successfully. The average reduction in thickness in the center (63 ± 69 µm; P = 0.0101) and periphery (129 ± 39 µm; P < 0.0001) before and after delamination was significantly different. One tissue showed signs of perforation during manual dissection and therefore considered unsuitable for transplantation. Primary graft failure was reported in one case, but it was not correlated with the tissue preparation. No other clinical complications were observed after surgery. CONCLUSIONS: Manual delamination of the stroma because of irregular microkeratome cutting is a viable option to obtain a uniform graft thickness required for DSAEK surgeries. This technique can further reduce tissue wastage that is observed after microkeratome cutting errors.

Standardizing Descemet Membrane Endothelial Keratoplasty Graft Preparation Method in the Eye Bank-Experience of 527 Descemet Membrane Endothelial Keratoplasty Tissues.

PURPOSE: To share the experience and provide a standardized protocol for Descemet membrane endothelial keratoplasty (DMEK) graft preparation. METHODS: A retrospective study based on 527 prestripped DMEK tissues that were prepared between 2014 and 2017. The experience of using different instruments and techniques has been described, and a standardized technique for preparing DMEK grafts has been identified. The tissues in general were prepared by superficially tapping the endothelial side with a Moria trephine (9.5 mm diameter). The plane of cleavage was identified using a cleavage hook, and the DMEK graft was deadhered from the trephined site throughout the circumference for ease of excising the graft. The DMEK graft was peeled using either one or multiple quadrant methods depending on the challenges faced during excision. The graft was finally marked with the letter "F" to identify the orientation during surgery. Data on endothelial cell loss (ECL) and challenging cases were observed, monitored, and recorded during this period. RESULTS: Less than 1 percent trypan blue-positive cells with tissue wastage of <6% was observed during the study period. Our standardized stripping technique has resulted in an overall ECL of 4.6%. Marking Descemet membrane showed 0.5% cell mortality. CONCLUSIONS: Standardizing DMEK technique using specific tools and simple techniques would help new surgeons to decide the instruments and improve their tissue preparation skills also in challenging cases such as previous cataract incisions or horseshoe-shaped tears, further reducing ECL or tissue wastage.

Formulating treatment recommendation as a logical consequence of the diagnosis in post-surgical oncological visits.

OBJECTIVE: the article analyzes how a doctor delivers diagnoses and recommends treatment in a set of post-surgical oncological visits. The pattern of activities are explored in two different cases: when all diagnostic information is available, and when information is still missing. METHODS: The data consist of 12 video-recorded visits of breast cancer patients to a senior oncologist. Conversation analysis is employed to analyze sequences in which the delivery of diagnosis and treatment recommendation unfold. RESULTS: The oncologist formulates the treatment recommendation as a logical consequence deriving from the available diagnostic information. In cases when definitive diagnostic information on the cancer type is missing, the oncologist opts to anticipate hypothetical diagnostic scenarios, and to draw the therapeutic alternatives as logical outcomes envisionable from each of the different scenarios. CONCLUSION: The communicative practice appears functional to encourage the patients' acceptance of a single treatment option rather than present the patients to and involve them in deliberating over multiple available treatment alternatives. PRACTICE IMPLICATIONS: Rather than a normative adoption of existing protocols of communication in cancer care, a better understanding of communication practices in use can help practitioners to reflect upon and make intentional choices about different arrangements for the patient's participation.

A superfusion apparatus for ex vivo human eye irritation investigations.

A superfusion apparatus (SA) was developed to maintain isolated human corneas ex vivo under conditions which mimic the natural eye environment in vivo, including controlled temperature, tear flow and intraocular pressure. The SA was designed, developed and tested for use in ophthalmic pre-clinical research and to test new pharmaceutical formulations. Corneas undergo an equilibration process in the new physiological environment for one day. The test was then initiated by the application of the test substance, incubation, and temporal assessment of corneal damage using various parameters. The effects of mild and severe irritant concentrations of NaOH (2% and 8%, respectively) on corneal opacity, swelling and epithelial integrity were studied, and the inflammatory status assessed using F4/80 and MPO as macrophages and neutrophils markers, respectively. The SA was then used to test new artificial tear formulations supplemented with silver ions as an active constituent, showing different degrees of inflammatory responses as indicated by the migration of MPO and F4/80 positive cells towards the epithelium. The human cornea superfusion apparatus was proposed as a model for acute eye irritation research.