Clinical Ophthalmology (Sep 2019)
Clinical Outcomes Of Descemet Membrane Endothelial Keratoplasty Using The Bonfadini-Todd Injector For Graft Insertion
Abstract
Mehrnaz Ighani, Sezen Karakus, Allen O Eghrari Division of Cornea, Cataract and External Diseases, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: Allen O EghrariDivision of Cornea, Cataract and External Diseases, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 1800 Orleans Street, Woods 375, Baltimore, MD 21287, USATel +1 410 955-5490Fax +1 410 614-9172Email [email protected]: To evaluate the clinical outcomes of using an Alcon intraocular lens (IOL) B cartridge for graft insertion during Descemet membrane endothelial keratoplasty (DMEK).Patients and methods: We retrospectively reviewed medical charts of patients who underwent DMEK using the Bonfadini-Todd injector, composed of an Alcon IOL B cartridge connected to plastic tubing and a syringe, for graft insertion between May 2016 and August 2018. Patient demographics, diagnoses, donor information, visual acuity, intraocular pressure (IOP), graft position and attachment status, pachymetry, and postoperative complications were recorded.Results: Twenty-four eyes of 23 patients with an average age of 72.8 ± 10.0 years (range, 48–87 years) were included. Mean follow-up duration was 13.3 ± 6.6 months (range, 3–26 months). Twenty-one (87.5%) patients had a primary diagnosis of Fuchs endothelial dystrophy, two (8.3%) patients had bullous keratopathy and one (4.2%) had Peter’s anomaly. Sixteen (66.7%) cases combined phacoemulsification and IOL implantation. Best-corrected visual acuity improved from a median of 0.398 logMAR preoperatively to 0.097 logMAR (P <0.001) at last follow-up examination, and central corneal thickness decreased from a median of 651 μm to 533.5 μm (P <0.001). Nine of 24 patients (37.5%) required re-bubbling due to partial graft detachment with a mean time of 12.1 ± 9.2 days (range, 5–35 days). One patient (4.2%) developed graft failure after re-bubbling and underwent Descemet stripping endothelial keratoplasty.Conclusion: The Alcon IOL B cartridge for DMEK graft insertion is safe and simple.Keywords: Descemet membrane endothelial keratoplasty, corneal transplantation, DMEK injector
