Dr. Goldman interviews Dr. Harvey about the recent discoveries in DSEK surgery presented during the ASCRS paper session. Topics include donor preparation, insertion techniques, as well as combined phaco/dsek vs staged procedure benefits.
Video Interview: Recent Discoveries in DSEK Surgery
Dr. David Goldman Interview with Dr. Tom Harvey
Dr. David Goldman: Hi, I'm David Goldman, Refractive Editor for OphthamologyWeb.com, speaking today with Dr. Tom Harvey, cornea specialist. I had the fortune of chairing the DSEK panel on today at the ASCRS session. Thanks for being here today, Tom.
Dr. Tom Harvey: It's my pleasure. Thanks, Dave.
Dr. David Goldman: You know, there were a lot of great papers presented during the session, as you and I are well aware of, but I just wanted to highlight some of the findings that we came across today.
Dr. Tom Harvey: Yeah, I thought it was a fantastic session. And this is very timely, as we're trying to find the connection between what we consider very successful and very safe surgery, which is Descemet's stripping anterior endothelial keratoplasty, and trying to marry that with even better visual results that we've seen preliminarily with DMEK, which is the stripping of Descemet's membrane from a donor and actually inserting without a stromal carrier.
We're realizing that there are technical challenges in the DMEK procedure; however, there have been some very interesting thoughts on how we can use ultrathin buttons, those under 100 microns, to have results that approach those of DMEK.
Dr. David Goldman: Yeah, exactly. And a lot of them talked about how, by just retaining a little bit of that stroma, it made the procedure that much more easy to perform.
And it was also interesting that there was a lot of discussion on what could be the best technique to fashion these ultrathin flaps, particularly doing a double pass with a microkeratome, whether it should be kept in the same orientation or different ones.
Dr. Tom Harvey: Sure.
And most of the procedures that are being used now are using the Moria artificial anterior chamber along with the Moria keratome to fashion the tissue. And the question is can thinner cuts, basically, result in a more--quick visual recovery with some improvement in ease of insertion?
I know when we've received precut tissue from the eye bank, it's very challenging to really have the best technician cut it every time, so there's been some variability. But, I think the bar has been raised in terms of tissue preparation, verification that the cells are healthy, and then, finally, the insertion and management of the air bubble.
Dr. David Goldman: And just to that point, you know, Dr. Malyugin's paper really showed that the ultrathin flaps really did result in better, more successful outcomes with this DSEK surgery.
And George Rosenwasser's paper also was very interesting in comparing phaco combined with DSEK compared to a staged or just DSEK surgery on its own.
Dr. Tom Harvey: Yeah, I think what's been observed, in the latter point from Dr. Rosenwasser's work, and highlighted by others, is that a thinner cornea to begin with, which is frequently in our triple patients, those that we're doing cataract surgery as well as the endothelial transplant, seem to have a better recovery and, perhaps, better ultimate vision. We're starting at a less damaged point as opposed to those that have pseudophakic bullous changes or severe--folks with epithelial edema.
I think when we're talking about thinner flaps, that may be quickly raising the bar for speed of recovery, as well as final visual outcomes. So, I think that this technique that Dr. Malyugin has suggested, using a 200-micron Moria keratome head with several passes, may allow us to have more predictable graft thickness, so we know exactly what we're inserting and, perhaps, doing a little bit better for our patients.
Dr. David Goldman: And another application as well that was talked about was endothelial keratoplasty for failed PK, and I think that we'll see a lot more of that as well going forward based on the results of what was presented today.
Dr. Tom Harvey: Yeah, I believe so.
I mean, I think the safety profile of replacing the damaged component of a failed graft, and we know that most failed grafts are due to endothelial failure, probably will make this much more common as we go ahead down the road.
And it's interesting to find that many patients have had their Descemet's membrane removed even from the penetrating transplants when, in the earlier years of endothelial keratoplasty, this was not necessarily recommended.
Dr. David Goldman: Well, thank you very much for joining us today.
Dr. Tom Harvey: Thank you, Dave.
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