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PURPOSE:: To describe specific maneuvers and technical modifications to the standardized “no-touch” technique of Descemet membrane endothelial keratoplasty (DMEK) to successfully handle the presence of a glaucoma drainage device (GDD) tube in the anterior chamber of an eye with a failed primary penetrating keratoplasty (PK) graft. METHODS:: A 42-year-old male patient underwent DMEK because of a failed primary PK graft in his phakic right eye. The patient was then evaluated at 3 and at 6 months after surgery. RESULTS:: A modified no-touch DMEK technique proved a feasible treatment option for a decompensated primary PK graft in the presence of a long GDD tube. CONCLUSIONS:: With specific technical modifications DMEK can be successfully performed in eyes with decompensated primary PK grafts in the presence of a long GDD tube. The very thin DMEK graft allows positioning between the GDD tube and the failed PK graft, leaving the tube in place. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Groeneveld-van Beek E.A.,Netherlands Institute for Innovative Ocular Surgery
Cornea | Year: 2016

PURPOSE:: To describe and compare 2 preparation techniques for Bowman layer (BL) grafts for use in BL transplantation. METHODS:: A retrospective evaluation of the 2 methods for preparing BL grafts was performed, that is, BL graft preparation from donor globes not eligible for penetrating keratoplasty or endothelial keratoplasty (technique I, n = 36) and BL graft preparation from previously excised corneoscleral buttons (technique II, n = 36) that could not be used for PK or had been denuded of Descemet membrane and endothelium for Descemet membrane endothelial keratoplasty graft preparation. BL graft preparation difficulties were recorded, and the preparation failure rate was examined and compared between the techniques. RESULTS:: Overall, BL graft preparation was successful in 51 cases (51/72; 70.8%), of which 25 preparations were successful using technique I, and 26 using technique II, representing a success rate of 69.4% (25/36) and 72.2% (26/36) for techniques I and II, respectively. Reasons for discarding a BL graft were tearing of the BL tissue during the preparation (n = 19) and stroma attached to the graft (n = 2). CONCLUSIONS:: Isolated BL grafts can be prepared from both whole donor globes and corneoscleral rims with equivalent success. Preparation from corneoscleral rims may offer the advantage that, from one donor cornea, the posterior layers can be used for Descemet membrane endothelial keratoplasty graft preparation and the anterior part for BL graft preparation. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source

Agency: Cordis | Branch: H2020 | Program: RIA | Phase: PHC-16-2015 | Award Amount: 6.03M | Year: 2016

Over 30 million Europeans are blind or visually impaired, leading to reduced quality of life and a tremendous loss of productivity in society. Corneal blindness is the second largest cause of blindness globally and while treatable, millions remain unnecessarily blind due to issues of access to transplantable tissue, lack of standardized treatments, and the lag in translating new regenerative medicine therapies to the clinic. The objective of ARREST BLINDNESS is therefore to develop and validate new regenerative-based therapies addressing a spectrum of blinding disorders of the cornea. These conditions either have no effective current treatments, depend on a scarce supply of donor tissue, or non-standardized methods are hindering validation of promising regenerative treatments. To achieve our objective, we will implant GMP-fabricated collagen-based bioengineered scaffolds to replace or regenerate the corneal stroma in cases of stromal thinning, scarring, dystrophy or trauma; deliver therapeutic epithelial stem and endothelial cells to the cornea to restore its transparency; deliver regenerative factors to promote neural growth and function; and actively maintain corneal immune privilege in high-risk situations by targeted therapeutic approaches to regress blood and lymphatic vessels. We will additionally develop advanced methods to image and monitor therapy throughout the cycle from GMP-compliant cell and scaffold preparation through the pre- and intra-operative stages, to postoperative follow-up and evaluation. After proof-of-concept and preclinical validation of key enabling components, these technologies will be used by one or several partners in preclinical models and in phase I/II human clinical studies. ARREST BLINDNESS directly addresses the translation of regenerative medicine, bio-artificial organs, tissue engineered scaffolds, and advanced cell and gene therapies into clinical use and will help to alleviate the worldwide problem of corneal blindness.

Parker J.S.,Netherlands Institute for Innovative Ocular Surgery | van Dijk K.,Netherlands Institute for Innovative Ocular Surgery | Melles G.R.J.,Netherlands Institute for Innovative Ocular Surgery
Survey of Ophthalmology | Year: 2015

Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients. © 2015 Elsevier Inc. Source

Lam F.C.,Netherlands Institute for Innovative Ocular Surgery | Bruinsma M.,Netherlands Institute for Innovative Ocular Surgery | Melles G.R.J.,Netherlands Institute for Innovative Ocular Surgery
Current Opinion in Ophthalmology | Year: 2014

PURPOSE OF REVIEW: To elaborate on the recent concept of Descemet membrane endothelial transfer (DMET) and to explore the concepts that underpin its success through reviewing the key articles that have challenged our current understanding of corneal endothelial cell behavior. RECENT FINDINGS: DMET challenges the paradigm that complete graft-host apposition is required for successful corneal clearance in endothelial keratoplasty. It offers the promise of a simpler procedure to restore corneal clarity. Its success may lie in the ability of endothelial cells to migrate and proliferate. Endothelial host cells have been found in isolation and at disparate locations among donor cells within the corneal buttons of patients who have had a penetrating keratoplasty. New evidence for the continued slow proliferation of endothelial cells from the corneal periphery throughout life comes from the microanatomy of the peripheral cornea, and the demonstration of stem cell markers and markers of DNA synthesis in this area. SUMMARY: DMET offers us a tantalizing taste of a simpler way of treating corneal endothelial disease by harnessing the ability of corneal endothelial cells to migrate and proliferate. An understanding of these processes will be the key stepping stone to developing future treatments for corneal endothelial disease. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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