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Diana Rodriguez, Randall Ulate Piedra, Erick Hernandez Bogantes; Split Donor Cornea Transplantation by Combined DMEK and DALK Surgeries in Costa Rica. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1295.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the feasibility of using a single cornea for two recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK) from a single eye bank in a developing country.
A retrospective, interventional, single-center study between October 20, 2015 and November 20, 2017 at the Clinica Oftalmologica in San Jose, Costa Rica was conducted. The indications for keratoplasty, age, gender, waiting time for surgery, follow-up, corrected distance visual acuity (CDVA) and complications were assessed.
A total of 102 patients with a mean age of 51,6 years ± 24.5 (48 men, 54 women [range, 16-91 years]) at the time of surgery were included. A single donor cornea could be used in 2 recipients in all of the cases. One case had primary failure one week after surgery and need penetrating keratoplasty (PK) nine months later. Fifty-one corneal tissues were transplanted with an average waiting time for surgery of 26.5 months. The average follow-up was 32,19 weeks.Overall, the preoperative CDVA in DALK was 1.29 logMAR and postoperative CDVA was 0.76 logMAR (p<0.05). The preoperative CDVA in DMEK was 1.81 logMAR and postoperative CDVA was 1.00 logMAR (p<0.05). Both groups altogether achieved a CDVA of logMAR 0.9 (p<0.05).Indications for DMEK were pseudophakic bullous keratopathy in 43 patients (84,31%), endothelial Fuchs dystrophy in 2 patients (3,92%), irido-corneal endothelial syndrome in 1 patient (1,96%), failed PK in 1 patient (1,96%) and failed DMEK in 4 patients (7,84%). Indications for DALK were keratoconus in 49 patients (96,07%) and corneal leukoma in 2 patients (3,92%). Previous surgical history was Ahmed valve in 6 patients (5,88%) intracorneal rings segments in 6 patients (5,88%) and trabeculectomy in 1 patient (0,98%). No intraocular infections occurred.
Split use of donor corneal tissue is a suitable technique to take advantage of the limited available donor tissue in developing countries and may ease the waiting time for surgery in order to achieve better anatomical and visual outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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