Eye Bank Preloaded, Injectable Ut-Dsaek In Cases Of Iris Abnormalities: A Surgeon First Experience

Published 2024 - 42nd Congress of the ESCRS

Reference: PP11.16 | Type: Free paper | DOI: 10.82333/523e-6611

Authors: Leonard Heydenrych* ¹ , Eric Abdullayev ² , Benjamin Lambright ³ , Art Kurz ⁴

¹Department of Cornea and External Eye Disease,Port Elizabeth Provincial Hospital and Cape Eye Hospital,Cape Town,South Africa, ²Innovation,Lions World Vision Institute,Tampa,United States, ³Clinical Director,Lions World Vision Institute,Tampa,United States, ⁴Director,Lions World Vision Institute,Tampa,United States

Purpose

Traditionally DSEK (Descemet Stripping Endothelial Keratoplasty) is performed with a ‘pull-through’ technique. This novel device, developed by the Lions World Vision Institute eye bank (LWVI, Tampa, USA) has modified DSEK to develop into a pre-loaded injectable delivery system, with the use of a syringe.

Setting

All patients were reviewed at an eye clinic in Cape Town, South Africa and surgeries were performed at a private eye hospital in Cape Town. One surgery was performed at Groote Schuur Hospital in Cape Town.

Methods

All grafts (n=11) were prepared at the LWVI and cut ultra-thin (UT) with a microkeratome, ‘S’ stamped and then loaded into a novel glass cannula with endothelium folded in, before being shipped to South Africa. Graft transit time to surgery was 4 days. Out of 11 patients – 1 had a failed penetrating keratoplasty (PKP), 2 had floppy iris syndrome, 3 patients had anterior chamber intra-ocular lenses, 7 had irregular and dilated pupils, 3 had large peripheral iridectomies with 1 patient having an artificial iris. The size of the main incision, number of sutures used, average time to correct graft unfolding and regression of corneal thickness were assessed.

Results

Surgeries were performed the day after graft arrival. The incision was 3.5 mm. All grafts unfolded independently and correctly orientated. 3-5 stitches were required to close the wound. The mean time from the graft entering the AC to complete unfolding was 149.05 seconds and to partial unfolding with correct orientation was 27.36 seconds. Mean central corneal thickness reduced by 242.25µm (29.56%). All grafts cleared within 4 weeks post-transplant. Mean 1 month post-operative visual acuity improved from hand movements to 0.31 (decimal).

Conclusions

A novel glass carrier allows secure storage of preloaded DSEK grafts with endothelium folded in and delivered the grafts by fluid insertion into the AC in the correct anatomical orientation with immediate streamlined unfolding, through the use of fluid dynamics, enabling the DSEK graft to open in complicated anterior chambers. Unfolding and injection of the DSEK graft has become quick and simplified, without the use of additional equipment, apart from injecting it into the AC with a syringe.