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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Article Info
Publication History
Published online: November 28, 2018
Accepted:
September 30,
2018
Received in revised form:
September 21,
2018
Received:
August 2,
2018
Identification
Copyright
© 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
