Advantages of Endothelial Keratoplasty
"Easier than manual, better than femtosecond, microkeratome DSAEK is a technique that every experienced surgeon can do and every hospital can afford" Pr Busin noted (Ocular Surgery News, April 2010).
UT-DSAEK vs Conventional DSAEK or DMEK/DMAEK
Pr. Busin showed that in 24 of 26 Ultra-thin DSAEK cases, he achieved central graft thickness of 100 microns or less. His personal results are included in the table below. 50% of the UT cases achieved 20/20 or better BSCVA, which is remarkable (ESCRS - Paris - September 2010).
Lastest publication with Moria One Use turbine by Prof Busin (Italy)
In their article 1, Busin et al. (Forlí, Italy) performed a retrospective study of eyes operated for DSAEK surgery during which all endothelial grafts were peroperatively prepared using the new linear microkeratome-assisted system with disposable heads of different sizes (ONE system, Moria SA, Antony, France) chosen according to a pachymetry-based nomogram.
Forty-two eyes were included in the study. The main outcome measure was the graft thickness as assessed by means of anterior segment optical coherence tomography, measured between 1 and 3 months postoperatively.
Investigators found that:
· for the 42 eyes included:
o no perforation or other complication occurred during graft preparation
o mean postoperative central thickness of donor grafts was 63 ± 29 [23-177] µm, with second thickest graft of 116 µm
o by 3 months postoperatively, 41/42 (97%) of the grafts were of thickness <130 µm and 38/42 (90%) of the grafts were of central thickness <100 µm
o graft profile: the mean nasal-to-temporal absolute thickness difference at the graft’s central 3-mm zone was 5 ± 7 µm at the last available measurement;
· for a subgroup of 23 eyes:
o mean endothelial cell loss was 27% ± 16%
o postoperative best corrected visual acuity was 0.2 ± 0.2 logMAR (approximately 20/32) at the last follow-up visit
o eighteen (78%) of these eyes had a best spectacle corrected visual acuity (BSCVA) of 20/40 or better, while four eyes (10%) had a BSCVA of 20/20 or better.
Based on their clinical study, Busin et al. therefore concluded:
“The nomogram developed at our institution allowed reliable single-pass microkeratome-assisted dissection of donor tissue, creating consistently thin and symmetric grafts without loss of tissue. The results obtained compare favorably with those reported in the past for double-pass microkeratome-assisted dissection of Ultra Thin-DSAEK.”
1. Nahum Y, Leon P, Busin M. Postoperative graft thickness obtained with single-pass microkeratome-assisted ultrathin descemet stripping automated endothelial keratoplasty. Cornea 2015;34(11):1362–1364
Ultra-Thin grafts: the next advance in corneal lamellar surgery
May 2011, Busin - Price
In this article, Dr Francis Price explains the rationale for ultra-thin endothelial grafts. To his opinion, with the ongoing evolution in endothelial keratoplasty techniques, thinner grafts make sense. "If thinner DSAEK grafts could be cut intentionally, there is a good reason to believe they might provide the same visual benefits of DMEK/DMAEK but with greater ease of preparation and handling and with a lower rate of dislocation".
Pr Massimo Busin gives in this article his personal experience in ultra-thin DSAEK technique. To his mind, this "new technique produces excellent visual results with the ease of handling and preparation of conventional DSAEK". Get the whole story...