Clinical Outcomes Of Descemet Membrane Endothelial Keratoplasty Using The Bonfadini-Todd Injector For Graft Insertion

Abstract

Purpose

To evaluate the clinical outcomes of using an Alcon intraocular lens (IOL) B cartridge for graft insertion during Descemet membrane endothelial keratoplasty (DMEK).

Patients and methods

We retrospectively reviewed medical charts of patients who underwent DMEK using the Bonfadini-Todd injector, composed of an Alcon IOL B cartridge connected to plastic tubing and a syringe, for graft insertion between May 2016 and August 2018. Patient demographics, diagnoses, donor information, visual acuity, intraocular pressure (IOP), graft position and attachment status, pachymetry, and postoperative complications were recorded.

Results

Twenty-four eyes of 23 patients with an average age of 72.8 ± 10.0 years (range, 48–87 years) were included. Mean follow-up duration was 13.3 ± 6.6 months (range, 3–26 months). Twenty-one (87.5%) patients had a primary diagnosis of Fuchs endothelial dystrophy, two (8.3%) patients had bullous keratopathy and one (4.2%) had Peter’s anomaly. Sixteen (66.7%) cases combined phacoemulsification and IOL implantation. Best-corrected visual acuity improved from a median of 0.398 logMAR preoperatively to 0.097 logMAR (P <0.001) at last follow-up examination, and central corneal thickness decreased from a median of 651 μm to 533.5 μm (P <0.001). Nine of 24 patients (37.5%) required re-bubbling due to partial graft detachment with a mean time of 12.1 ± 9.2 days (range, 5–35 days). One patient (4.2%) developed graft failure after re-bubbling and underwent Descemet stripping endothelial keratoplasty.

Conclusion

The Alcon IOL B cartridge for DMEK graft insertion is safe and simple.

Keywords:

• Descemet membrane endothelial keratoplasty
• corneal transplantation
• DMEK injector

Acknowledgments

The authors thank Ms. Jennifer Perkins, the senior medical office coordinator at the Division of Cornea, Cataract, and External Diseases of the Wilmer Eye Institute, who acquired donor tissue information from the eye banks. Some contents of this manuscript have been presented at the 2018 American Society for Cataract and Refractive Surgery and American Society of Ophthalmic Administrators (ASCRS ASOA) annual meeting. This research did not receive any external financial support from funding agencies in the public, commercial, or not-for-profit sectors.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Eghrari is supported by the Prevention of Blindness Sybil B and Harrington Special Scholar Award and has ownership interest in Treyetech and LuckyVision, LLC. Dr Eghrari reports personal fees from Keralink, outside the submitted work. In addition, Dr Eghrari has a patent DMEK insertion device pending. The authors report no other conflicts of interest in this work.