DMEK and Cataract Surgery Among Topics Discussed

Educational Event in Armadale, Melbourne

I joined my colleagues from Armadale Eye Clinic on June 21 at Barca Restaurant in Armadale to offer an educational event.  The event was centred on updates on corneal transplant techniques, refractive surgery technology and medical and surgical retina topics.

In the talk entitled, DMEK: Anatomic Replacement of Diseased Endothelium, I discussed my experience with DMEK, the learning curve of the technique, eye-banking considerations to improve outcomes, and the growth in popularity of the this technique in Australia and worldwide.  Some of the take-home points from the talk are that DMEK grafts are approximately 10 times thinner than the average DSAEK graft and are 10 times less likely to reject compared to DSAEK.  The below images are anterior segment OCTs of a DSAEK graft and a DMEK graft at 3 months after surgery, showing the difference in graft thickness.  Although the technique is more challenging to perform and learn, the combination of better visual acuity results, more rapid improvement in vision, and reduced rejection risk are major advantages of DMEK.  The subject matter was of great interest to many in attendance as it generated many questions relating to all aspects of the procedure. 

DSAEK anterior segment OCT

Anterior Segment OCT of DSAEK at 3 months. Note DSAEK graft thickness of 140 micrometers (0.14 mm).

DMEK anterior segment OCT

Anterior segment OCT of DMEK graft at 3 months. Note the anatomic appearance of the endothelial graft.

The retina portion of the evening included a presentation on polypoidal choroidal vasculopathy (PCV), a variant of age-related macular degeneration.  PCV is a disease of the choroidal vasculature that is characterised by detachments of pigmented epithelium, exudative changes and sub-retinal fibrosis.   Both diagnostic pearls and treatment paradigms were discussed.  This was followed by an update on the management of diabetic retinopathy in the presence of cataract.  Cataract surgery can cause progression of diabetic retinopathy.  It was emphasised that prior to cataract surgery the blood sugar should be well controlled, proliferative retinopathy should be treated with pan-retinal photocoagulation or anti-VEGF injections, and macular oedema can be treated with either focal laser, anti-VEGF or steroid injections.  If it is not possible for laser to be placed ahead of surgery, intravitreal injections can be given before or at the time of surgery with the potential for laser to be given later. 

The final talk of the night highlighted small incision lenticule extraction (SMILE), a new corneal refractive procedure that does involve the use of an excimer laser.  Instead, a femtosecond laser cuts a small lenticule within the cornea, and this lenticule is removed through a small incision.   It may have a benefit over LASIK with increased biomechanic stability, less dry eye, and more rapid reinnervation of corneal nerves.  The technique currently has limitations in treating low myopes and hyperopes, but I am sure we will hear more about this as the technology improves. 

Ross MacIntyre MD FRANZCO

Comprehensive Ophthalmologist

Melbourne, Australia

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