the cornea, transplants and specialized cuts
DESCRIPTION
Gregory Schmidt, BS, CBTE Director of Tissue Preparation and Research, Iowa Lions Eye BankTRANSCRIPT
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The Cornea, Transplants and Specialized Cuts
Gregory Schmidt, BS, CEBTDirector of Tissue Preparation and Research
Iowa Lions Eye Bank
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Layers of the Cornea
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The Endothelium
Single layer of cells\Uniform in shape and density
Acts as a pumping mechanism
Cells do not proliferate Loss of cells results in enlargement/migration of neighboring cells
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Trends and changes in eye banking occur to keep up with the advances in surgical techniques.
DSAEK – 2005 (North Carolina Eye Bank)IEK – 2006 (SightLife)DMEK/DMAEK – 2009 (Iowa Lions Eye Bank)
Surgical Trends
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Penetrating Keratoplasty
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Penetrating Keratoplasty ‐ LAK
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Penetrating Keratoplasty – LAK Mushroom
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Penetrating Keratoplasty – LAK Tophat
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Penetrating Keratoplasty – LAK ZigZag
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Amount of time to achieve BVA (3‐12 months) Greater surface area to promote stronger wound healing
Astigmatism
Penetrating Keratoplasty
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23,26921,970
21,620 21,422 20,954
18,22119,159
21,55523,049
24,987
1,116 1,5133,021
2,213 2,288
0
5,000
10,000
15,000
20,000
25,000
30,000
2009 2010 2011 2012 2013
EBAA Domestic Transplants by Type5‐year Data 2009‐2013
PKP EK Other
Surgical Trends
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Endothelial Keratoplasty (EK)
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EK ‐Microkeratome
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EK ‐Microkeratome
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DSAEK Graft
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Visual recovery is shorter (2‐6 weeks) No induced astigmatism Refractive shift Small incision – stronger globe strength
Endothelial Keratoplasty
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DMEK Grafts
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Fast visual recovery No refractive shift Smaller incision
DMEK Grafts
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DMEK ‐Microkeratome
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Where the bubble begins – DMEK/DMAEK Surgeon request for DMAEK prepared grafts Surgeon feedback Scrolls were tight
DMEK ‐Microkeratome
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FS‐DMAEK
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Surgeons shifted the request for DMEK tissue Comfort and improvements with the procedure Increase in request for eye bank prepared tissue
Surgeon Trend
0 1 1
4
9
5 7
5
8
4
10 10 9
11 10
14
17
21
0
5
10
15
20
25
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How is the graft prepared? Peeled vs. Big bubble
Surgeon preference What’s best for the eye bank – peeled (91% success rate)
Surgeon Trend
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DMEK ‐ Peeled
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Images on Slit Lamp
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Learning Curve Beyond the manual dexterity
Donor Selection Age Does the donor’s medical history influence outcomes?
No diabetic tissue – 97% success rate Consistency amongst preparation type Customized to the surgeon’s specific request
Designated graft size (8.0mm, 8.5mm, or 9.0mm) Specific peripheral markings – use of the “S” stamp
Better results/Improvements
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What are we working on now?
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Seahorse
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Seahorse
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Seahorse
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For more information
Greg Schmidt, BS, CEBTIowa Lions Eye BankGregory‐[email protected]
Thank You
Questions?