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David Buickians, Michael Mbagwu, Charles C. Lin, David Myung; A novel device for descemetorhexis creation: 3D Printed Prototype Design and Ex Vivo Evaluation. Invest. Ophthalmol. Vis. Sci. 2021;62(8):978.
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Corneal transplantation over the last decade has increasingly shifted towards selectively addressing pathologic layers as opposed to full-thickness tissue replacement. Such procedures include DMEK (Descemet's membrane endothelial keratoplasty), DSAEK (Descemet Stripping Automated Endothelial Keratoplasty), and DSO (Descemet’s Stripping Only). In many cases, these newer procedures have led to improved final visual acuity, faster recovery times, and decreased incidence of graft rejection. Proper descemetorhexis is a critical step in these surgeries to avoid potential complications such as graft detachment, and stromal scarring.
Several variants of a handheld surgical device apparatus were designed to allow insertion into the anterior chamber through a standard 2.4 mm corneal incision. Parametric device designs were created using computer-aided design (CAD) software. An SLA 3D printer (Form 2, Formlabs ©) was used for prototyping using a commercially available, biocompatible resin. Prototypes were evaluated for their potential descemetorhexis application using ex vivo porcine eyes. The quality of descemetorhexis creation and relative ease of use were assessed. Results from empirical testing were then used to iterate and refine the design.
Several prototypes were created, each evaluated based on intraocular manipulation stability, ease of use, and ability to create a circular descemetorhexis at the appropriate depth. Current device iterations— which include magnetically controlled, mechanically controlled, and a combined magnetic and mechanically controlled scoring of Descemet’s membrane— resulted in successful descemetorhexis creation with minimal damage to neighboring anatomic structures.
A novel surgical device for descemetorhexis creation was created with a 3D printer for rapid prototyping, using an iterative design process. Prototypes were successfully used to create a circular descemetorhexis in ex vivo porcine eyes. Future work will be directed toward necessary design improvements and testing in vivo.
This is a 2021 ARVO Annual Meeting abstract.
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