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Learning curve of two common Descemet membrane endothelial keratoplasty graft preparation techniques

Published:November 28, 2018DOI:https://doi.org/10.1016/j.jcjo.2018.09.008

      ABSTRACT

      Objective

      To compare the learning curve of two Descemet membrane endothelial keratoplast (DMEK) graft preparation techniques.

      Design

      Experimental study.

      Participants

      Twenty paired donor corneoscleral rims.

      Methods

      The corneas were randomized to DMEK peeling using the peripheral blunt dissection technique (n = 10) or the modified submerged cornea using backgrounds away (mSCUBA) technique (n = 10). Outcome measures included graft peeling time, surgeon's peeling difficulty grading (on a scale of 1 to 10, 1 being the easiest and 10 the hardest), number of tears, and percentage tissue loss.

      Results

      Average graft peeling time using the peripheral blunt dissection technique and the mSCUBA technique was 15.75 ± 4.01 minutes and 8.43 ± 3.26 minutes, respectively (p < 0.0005). The first 3 grafts’ average peeling time was longer than the last 7 grafts: 19.14 ± 2.40 versus 14.21 ± 3.50 minutes in the peripheral blunt dissection technique (p = 0.06) and 12.36 ± 3.76 versus 6.67 ± 0.49 minutes in the mSCUBA technique (p = 0.016). In the latter, there were significantly fewer radial tears compared to the former: 1.5 ± 1.0 and 3.1 ± 1.9, respectively (p = 0.049). No tissue loss was noted in the mSCUBA group compared to one (10%) in the peripheral blunt dissection group. The average difficulty grading for the mSCUBA was significantly lower than the peripheral blunt dissection technique: 3.3 ± 1.9 and 5.8 ± 1.6, respectively (p = 0.024).

      Conclusions

      Our study suggests a shorter learning curve with the mSCUBA technique for DMEK graft preparation, with shorter peeling time and fewer complications in comparison to the peripheral blunt dissection technique.

      Résumé

      Objectif

      Comparer la courbe d'apprentissage de 2 techniques de préparation du greffon en vue d'une kératoplastie endothéliale de la membrane de Descemet (DMEK, pour Descemet's membrane endothelial keratoplasty).

      Nature

      Étude expérimentale.

      Participants

      Dix paires de disques sclérocornéens provenant de donneurs.

      Méthodes

      Après randomisation, les cornées ont subi un pelage de l'endothélio-Descemet au moyen de l'une des 2 techniques suivantes : technique de dissection périphérique non tranchante (DPNT; n = 10) ou technique SCUBA (pour submerged cornea using backgrounds away) modifiée (mSCUBA; n = 10). Les paramètres de mesure comprenaient le temps de pelage du greffon, l’évaluation du degré de difficulté du pelage selon le chirurgien (sur une échelle de 1 à 10, 1 correspondant au degré de facilité le plus élevé et 10, au degré de difficulté le plus élevé), le nombre de déchirures et le pourcentage de perte de tissu.

      Résultats

      La durée moyenne du pelage du greffon selon que le chirurgien a utilisé la technique DPNT ou la technique mSCUBA s’élevait à 15,75 ± 4,01 minutes et à 8,43 ± 3,26 minutes, respectivement (p < 0,0005). La durée moyenne du pelage des 3 premiers greffons était plus longue que celle des 7 derniers greffons : 19,14 ± 2,40 vs 14,21 ± 3,50 minutes dans le cas de la technique DPNT (p = 0,06) et 12,36 ± 3,76 vs 6,67 ± 0,49 minutes dans le cas de la technique mSCUBA (p = 0,016). Le nombre de déchirures radiales a été significativement moindre avec la technique mSCUBA qu'avec la technique DPNT : 1,5 ± 1,0 et 3,1 ± 1,9, respectivement (p = 0,049). Aucune perte de tissu n'a été observée dans le groupe mSCUBA, comparativement à 1 (10 %) dans le groupe DPNT. La cote de difficulté moyenne attribuée à la technique mSCUBA était significativement moins élevée que celle accordée à la technique DPNT: 3,3 ± 1,9 et 5,8 ± 1,6, respectivement (p = 0,024).

      Conclusions

      Selon notre étude, la technique mSCUBA pour la préparation du greffon en vue d'une DMEK est plus simple à apprendre, s'accompagne d'une durée de pelage plus courte et entraîne moins de complications que la technique DPNT.
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