{"id":11480,"date":"2020-06-28T03:05:44","date_gmt":"2020-06-28T00:05:44","guid":{"rendered":"https:\/\/drborismalyugin.com\/operatsiya\/corneal-transplantation\/endotlialnaya-keratoplastika"},"modified":"2020-08-22T21:59:54","modified_gmt":"2020-08-22T18:59:54","slug":"endothelial-keratoplasty","status":"publish","type":"operatsiya","link":"https:\/\/drborismalyugin.com\/en\/operatsiya\/corneal-transplantation\/endothelial-keratoplasty","title":{"rendered":"Endothelial keratoplasty (Descemet Membrane Endothelial keratoplasty &#038; Descemet\u2019s Stripping Automated Endothelial Keratoplasty)"},"content":{"rendered":"<section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_middle type_default stacking_default\"><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>About two decades ago, penetrating keratoplasty or full-thickness corneal transplantation was almost exclusively used to eliminate corneal blindness. Thanks to the latest developments in ophthalmic surgery, the possibilities for corneal transplantation have reached the new heights. Nowadays, the exclusive lamellar replacement of affected corneal areas is possible and used in various circumstances.<\/p>\n<p>Endothelial keratoplasty allows the surgeon to restore the patient&#8217;s vision without replacing the outer part of the cornea (corneal epithelium, Bowman\u2019s membrane, and stroma).<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-message color_green with_icon\"><div class=\"w-message-icon\"><i class=\"fas fa-check\"><\/i><\/div><div class=\"w-message-body\"><p>As a recognized authority in anterior segment surgery, Boris Malyugin has performed more than 1,000 keratoplasties over the course of his carrier. He is the author of multiple scientific papers, books, and surgical atlases.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom color_alternate\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">Endothelial keratoplasty techniques<\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>Modern corneal transplantation is carried out taking into account the morphology of the cornea, which consists of five layers of tissue:<\/p>\n<ul>\n<li>Epithelium.<\/li>\n<li>Bowman\u2019s membrane.<\/li>\n<li>Stroma.<\/li>\n<li>Descemet\u2019s membrane.<\/li>\n<li>Endothelium.<\/li>\n<\/ul>\n<p>The modern approach to corneal transplant surgery is tissue-selective. The surgeon replaces only the damaged area of the cornea with a lamellar donor transplant. In the case of endothelial keratoplasty, the posterior part, containing corneal endothelial cells, is replaced. This is a very important monolayer of cells that maintain the transparent state of the cornea by ensuring the optimal balance of water and nutrients. If the endothelium is damaged, the cornea begins to swell and become cloudy. As a result, the vision is decreased.<\/p>\n<p>Endothelial keratoplasty is carried out in one of two main modalities: Descemet\u2019s membrane endothelial keratoplasty (DMEK) and Descemet\u2019s stripping endothelial keratoplasty (DSEK). In DMEK, the transplant contains exclusively Descemet&#8217;s membrane and endothelium (with a thickness of about 30 microns). In DSEK, the transplant is cut out along with a thin strip of corneal stroma, with a thickness varying from 60 to 200 microns.<\/p>\n<p>Endothelial keratoplasty has several advantages:<\/p>\n<ul>\n<li>The incision is small, not exceeding 5 mm; it requires minimal or even no sutures.<\/li>\n<li>The \u00abclosed chamber\u00bb technique significantly reduces intra- and postoperative risks.<\/li>\n<li>In combined procedures (with cataract extraction and intraocular lens (IOL) implantation), it is possible to calculate the appropriate IOL optical power with a high degree of accuracy.<\/li>\n<li>The postoperative rehabilitation period is significantly reduced.<\/li>\n<li>Long-term use of postoperative medications is not required.<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">Endothelial keratoplasty indications<\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>This type of corneal transplantation is recommended for replacement of diseased endothelium in the following cases:<\/p>\n<ul>\n<li>Bullous keratopathy (clouding of the cornea after cataract surgery or trauma).<\/li>\n<li>Congenital hereditary endothelial dystrophy.<\/li>\n<li>Fuch\u2019s endothelial corneal dystrophy.<\/li>\n<li>Endothelial dysfunction of the earlier transplanted penetrating corneal graft.<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_auto width_full\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><section class=\"l-section wpb_row us_custom_938809ae height_auto color_primary\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_middle type_default reversed stacking_default\"><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-image us_custom_1fd2f432 style_shadow-1 align_center\"><div class=\"w-image-h\"><img decoding=\"async\" width=\"358\" height=\"512\" src=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/malyugin-3-358x512.jpg\" class=\"attachment-medium size-medium\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/malyugin-3-358x512.jpg 358w, https:\/\/drborismalyugin.com\/wp-content\/uploads\/malyugin-3.jpg 601w\" sizes=\"auto, (max-width: 358px) 100vw, 358px\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-6 wpb_column vc_column_container has_bg_color stretched\"><div class=\"vc_column-inner us_custom_df02dd93\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_contrast align_center no_text\"><a href=\"tel:+74999065001\" class=\"w-iconbox-link\" aria-label=\"+7 (499) 906-50-01\"><div class=\"w-iconbox-icon\" style=\"font-size:2rem;\"><i class=\"fal fa-phone-alt\"><\/i><\/div><\/a><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\"><a href=\"tel:+74999065001\" class=\"w-iconbox-link\" aria-label=\"+7 (499) 906-50-01\">+7 (499) 906-50-01<\/a><\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p style=\"text-align: center;\">You can make an appointment by phone from 8:30 to 19:30 (daily).<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n<\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">Contraindications<\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>Transplantation of the posterior corneal layers is a microinvasive procedure. It requires skill with a number of special microsurgical instruments.<\/p>\n<p>Contraindications to endothelial keratoplasty include:<\/p>\n<ul>\n<li>Significant decrease in the transparency of the cornea, preventing the surgeon to clearly control manipulations inside the eye.<\/li>\n<li>Pronounced iris defects.<\/li>\n<li>Aphakia (absence of the lens).<\/li>\n<li>Vitreous absence (avitria).<\/li>\n<li>Chronic hypotension (after antiglaucoma tube-shunt surgery).<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom color_alternate\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-message us_custom_0490361b color_red with_icon\"><div class=\"w-message-icon\"><i class=\"fas fa-engine-warning\"><\/i><\/div><div class=\"w-message-body\"><p>If these conditions are detected, different methods of keratoplasty should be considered. Sometimes combined reconstructive interventions, such as endothelial keratoplasty with IOL implantation, can be considered. <\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h3 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">How is the surgery performed?<\/h3><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>The surgical procedure involves either general or local anaesthesia, depending on the age and health condition of the patient.<\/p>\n<p>The surgery involves several steps:<\/p>\n<ul>\n<li>The patient is prepared for surgery.<\/li>\n<li>Lamellar corneal transplant containing endothelial layer is cut from the donor cornea.<\/li>\n<li>A small tunnel incision is created in the eye wall.<\/li>\n<li>The patient\u2019s endothelium and Descemet&#8217;s membrane are separated and removed.<\/li>\n<li>The endothelial transplant is inserted in the folded state.<\/li>\n<li>The transplant unfolds and is fixed with an air or gas bubble to the recipient\u2019s posterior corneal layers.<\/li>\n<li>The wound is closed.<\/li>\n<\/ul>\n<p>It is worth noting that the preparation of the lamellar corneal transplant can be carried out manually, or by using a microkeratome or femtosecond laser. The surgeon makes this choice based on their preferred technique and status of the eye.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"featured_media":11604,"parent":11459,"menu_order":0,"template":"","meta":{"footnotes":""},"categories":[80],"tags":[],"class_list":["post-11480","operatsiya","type-operatsiya","status-publish","has-post-thumbnail","hentry","category-procedures"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya\/11480","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya"}],"about":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/types\/operatsiya"}],"version-history":[{"count":0,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya\/11480\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya\/11459"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/media\/11604"}],"wp:attachment":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/media?parent=11480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/categories?post=11480"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/tags?post=11480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}