KMID : 0213520130270020087
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Korean Journal of Ophthalmology 2013 Volume.27 No. 2 p.87 ~ p.92
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Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty
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Kang Sug-Jae
Kim Myung-Hun Kim Mee-Kum Wee Won-Ryang Lee Jin-Hak Chung Eui-Sang
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Abstract
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Purpose: To investigate effects of a new push-through insertion method for donor lenticules using an injector system on endothelial viability ex vivo and in a clinical case series of endothelial keratoplasty.
Methods: An ex vivo delivery model was used with porcine corneoscleral rims. We compared the endothelial viability in a new push-through insertion method using the Visian Implantable Collamer Lens (ICL) injector versus that of standard forceps-assisted insertion for lenticule delivery. Twenty porcine corneal lenticules were divided into four groups by insertion method and wound size. Vital dye staining was performed and devitalized areas were semi-quantitatively assessed by digital imaging. In the clinical case series, Descemet¡¯s stripping endothelial keratoplasty (DSEK) using the push-through method was performed in seven patients and endothelial outcome was determined six months postoperatively.
Results: Mean devitalized areas for the push-through method were significantly lower than for forceps-assisted insertion through 3.2 mm incision (23.99 ¡¾ 2.17% vs. 50.48 ¡¾ 5.07%, p = 0.009) in the ex vivo model. Average endothelial cell counts of donor tissues of patients who underwent DSEK were 26.4% lower six months postoperatively.
Conclusions: Push-through delivery of donor lenticules using the Visian ICL injector system appears to be less harmful to endothelial cells than conventional forceps-assisted delivery.
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KEYWORD
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Descemet¡¯s stripping endothelial keratoplasty, Endothelial viability, Visian implantable collamer lens injector system
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