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Peter B Veldman, Zachary Mayko, Michael D Straiko, Mark A Terry; Six-Month Clinical Outcomes of Our Initial 30 Stromal Sided S-Stamped Descemet Membrane Endothelial Keratoplasty (DMEK) Cases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):882.
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To report the direct comparison of clinical outcomes in our initial 30 DMEK transplants incorporating an S-Stamp for graft orientation, to the 32 consecutive unstamped DMEK transplants preceding its use.
Thirty consecutive patients underwent DMEK surgery utilizing a previously validated and reported stromal sided S-stamp technique (Cornea/EBAA Meeting 2013) between August and October of 2013. Data was collected prospectively, including anterior segment OCT, tomography and 6 month endothelial cell density. Additionally, the clinical course was documented including need for re-bubbling, graft failure, graft rejection or other post-operative complications. Comparison was made to similar 6 month data from the preceding 32 consecutive unstamped DMEK procedures completed utilizing our otherwise identical DMEK surgical technique.
To date, in the initial 30 DMEK transplantations utilizing the S-stamp there was one re-bubble required (1/30), compared to one re-bubble in the 32 preceding unstamped DMEK cases (1/32), demonstrating no statistically significant difference between the two groups (p=0.962). There have been no primary graft failures to date in the 30 cases in the S-stamp group (0/30) compared to four in the unstamped cases (4/32), all of which were due to iatrogenic causes (3 upside down grafts, 1 break in technique). This difference in graft failure was statistically significant (p=0.045). There have been no rejection events in either group to date. Six month endothelial cell data (not available at time of abstract submission) will provide direct comparison of endothelial cell loss associated with the S-stamp.
Preliminary clinical data suggests that a stromal sided S-stamp can be utilized to safely and effectively orient DMEK grafts and prevent upside down graft placement, a known cause of primary graft failure. Further, comparison of 6 month endothelial cell loss between 30 consecutive S-stamped and the preceding 32 consecutive unstamped tissues will allow a concrete comparison of the endothelial cell damage attributable to the S-stamp. This comparison will be useful in determining the continued utility of S-stamp graft orientation in DMEK surgery.
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