Official ESCRS | European Society of Cataract & Refractive Surgeons


Clinical evaluation of deeply manually stripped endothelial automated keratoplasty (DMSEAK) as a new ultrathin endothelial keratoplasty

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Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 08:30

Venue: Free Paper Forum: Podium 3

First Author: : D.Touboul FRANCE

Co Author(s): :    E. Coirier   V. Saunier                          

Abstract Details


The aim of this study was to describe the postoperative outcomes of a new ultra-thin endothelial keratoplasty we called Deeply Manually Stripped Endothelial Automated Keratoplasty (DMSEAK).


Ophthalmology department, Bordeaux university and hospital center


30 eyes of 30 patients with corneal endothelial dysfunction underwent consecutively a DMSAEK procedure. All DMSEAK were performed by cutting the donor tissue with a mechanical microkeratome (MORIA) targeting 150 microns and then enhanced by a manually lamellar stripping approach assisted by intraoperative OCT (RESCAN-Zeiss). That OCT guided procedure aimed to achieve a donor graft thickness in-between 50 and 100 microns by peeling the remaining tissue by a simple mechanical lamellar stripping. Graft injection was archived by pull-through technique. Complications, best-corrected visual acuity (BCVA), OCT central corneal thickness (CCT) and graft thickness (CGT) were assessed before surgery and post-operatively (CASIA2-Tomey).


The mean intraoperative CGT were 156 μm (SD 37) and 67 μm (SD 20) after microkeratome cuts and after completing the manual dissection respectively. The mean post op CGT, was 72 μm (SD 13); 63 μm (SD 12); 61 μm (SD 16); 62 μm (SD 18) respectively at 1,3,6 and 12-months post op respectively. BCVA was 0.16 preoperatively and was 0.5; 0,7; 0.8 and 0.8 at 1,3, 6 and 12 months postoperatively respectively. We excluded 6 eyes from these results due to macular dysfunction, significant cataract or corneal opacity. Re-bubbling after surgery was required for 3 eyes.


DMSEAK procedure allows extra thin grafts, in-between 100 μm and 50 microns without compromising the cutting safety. Good quality of vision and low rate of detachment could make this procedure an interesting compromise between conventional UT-DSEAK and DMEK procedures. Further larger studies with longer follow-up remains necessary to conclude.

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