Combined DMEK and Cataract Surgery (DMEK Triple) in a Patient with Ectropion Uveae | Dr. Nallasamy скачать в хорошем качестве

Combined DMEK and Cataract Surgery (DMEK Triple) in a Patient with Ectropion Uveae | Dr. Nallasamy

Descemet Membrane Endothelial Keratoplasty (DMEK) and Cataract Surgery in a patient with Fuchs Dystrophy and Ectropion Uveae performed by Dr. Nambi Nallasamy | Corneal Transplantation at University of Michigan Kellogg Eye Center Fuchs dystrophy is a condition of the cornea (the clear dome over the eye) in which progressive loss of endothelial cells occurs. These endothelial cells serve to pump fluid out of the cornea in order to ensure that it maintains its clarity and shape. In addition to loss of endothelial cells, Fuchs dystrophy results in formation of guttae – microscopic bumps near the inside surface of the cornea (inside Descemet’s membrane). Fuchs dystrophy can become symptomatic due to haze and fluctuation of the vision resulting from swelling of the cornea. It can also become symptomatic due to glare induced by guttae (bumps in Descemet’s membrane). Modern treatment of Fuchs dystrophy involves performing a partial-thickness corneal transplant called Descemet Membrane Endothelial Keratoplasty (DMEK). DMEK transplants are extremely thin, and involve the like-for-like replacement of just 10 microns (10 millionths of a meter!) of corneal tissue. A DMEK transplant involves removing the Descemet’s membrane and endothelium of the patient and replacing it with the same two layers of tissue from a donor. Often, DMEK surgery will be combined with cataract surgery to address an existing cataract and reduce the potential for damage to the DMEK transplant in the future. This combined surgery, in which a cataract is removed, an intraocular lens (IOL) implant is placed, and a DMEK is performed is also called a DMEK Triple. Here, Dr. Nallasamy (cornea and anterior segment surgeon at University of Michigan Kellogg Eye Center) performs cataract surgery immediately followed by DMEK in a patient with Fuchs dystrophy and ectropion uveae. Ectropion uveae is a term used to describe the area of pigmentation seen near the pupil margin. DMEK surgery has several benefits over older forms of corneal transplantation for Fuchs dystrophy, including greater visual potential, faster recovery time, and lower risk of rejection. 0:04 -- Starting the Cataract Surgery (cataract surgery is done first in a combined cataract and DMEK procedure) 1:30 -- Injecting the new intraocular lens (IOL) implant 1:38 -- Starting the DMEK portion of the surgery. The cornea is marked to guide the removal of the patient's Descemet's membrane. 1:57 -- Descemet's membrane is scored using an instrument called a reverse Sinskey hook in a circular pattern that matches the markings on the outer surface of the cornea 2:10 -- The central 8mm of Descemet's membrane and endothelium are removed from the inner surface of the cornea 2:56 -- A suture is preplaced in the main incision to ensure easy closure 3:10 -- Viscoelastic (gel) is removed from the eye to prepare for the insertion of the transplant tissue 3:24 -- Medication is used to reduce the size of the pupil in preparation for the insertion of the transplant tissue 3:40 -- The transplant (donor) tissue is injected into the eye 4:24 -- The tissue is oriented (using the S-stamp as a guide) and centered. A series of fluid waves and tapping maneuvers are used to position the transplant. 5:02 -- A gas bubble is injected underneath the transplant to help it attach to the back surface of the patient's cornea 5:46 -- The eye with gas bubble in place at the end of the surgery 5:52 -- The patient's eye after resolution of the gas bubble. Since the transplant is extremely thin, it is difficult to discern even on this magnified view. The pigmentation at the upper right of the pupil is due to a separate condition called ectropion uveae. The cornea is clear, and the patient achieved 20/20 vision. Follow Dr. Nambi Nallasamy on Twitter for more updates: @Dr_Nallasamy   / dr_nallasamy      • Nambi Nallasamy, M.D. | Cornea Surgeon, Mi...