Use of Single Donor Cornea for 2 Lamellar Transplantation Procedures: DMEK and DALK

Teichman, Joshua

Use of Single Donor Cornea for 2 Lamellar Transplantation Procedures: DMEK and DALK

Friday, April 25, 2014

KIOSKS (Boston Convention and Exhibition Center)

Joshua C. Teichman, MD, MPH, University of Ottawa Eye Institute, Oakville, ON, Canada

Larena Tay, BSc, University of Ottawa Eye Institute, Ottawa, ON, Canada

Salina Teja, MD, University of Ottawa Eye Institute, Ottawa, ON, Canada

Ronan J. Conlon, MD, University of Ottawa, Ottawa, ON, Canada

Kashif Baig, MD, MBA, Ottawa Eye Institute, Ottawa, ON, Canada

Narrative Responses:

Purpose
To assess the intraoperative issues and surgical outcomes of preparing a single donor corneal tissue for same-day use in DMEK and DALK.

Methods
Five dual-purpose corneoscleral rims were used to prepare tissue for 5 DMEK patients and 5 DALK patients. A trephine-peel SCUBA technique was first used to harvest the 5 DMEK grafts, and the remaining tissue was used for the 5 DALK grafts. Tissue preparation and operative used occurred on the same day. Tissue preparation challenges, intraoperative complications, and visual recovery were assessed.

Results
There were no difficulties in preparing the 5 dual-purpose tissues, and all 10 lamellar transplants were completed successfully. At six-month follow-up, mean best corrected spectacle distance visual acuity improved from 20/250 to 20/80 in the 5 DALK patients and from 20/300 to 20/25 in the 5 DMEK patients. Post-operative complications after DALK included retained viscoelastic agent at the interface in one patient, and a double anterior chamber managed with re-bubbling in another. After DMEK, a peripheral partial graft detachment occurred in one patient and was managed with re-bubbling. All corneas demonstrated clarity on slit-lamp examination.

Conclusion
A single donor corneal graft can be used for both DMEK and DALK, and may represent a more efficient use of corneal tissue. Complications with the preparation of dual-purpose tissue were not encountered.