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The ALTK-CBm system

I-MED Surgical offers MORIA's the full range of completely sterilizable devices necessary to perform all the steps of Endothelial Keratoplasty procedures:

  • CBm microkeratome with multiple heads and suction rings, and the Artificial Anterior Chamber, which allows removal of an anterior lamellar cap from the posterior portion.
  • Hanna Punch Block and the ONE disposable corneal vacuum  punch (several diameters available) to perform the lamellar trephination.
  • Hand-held instruments for each step of the procedure.
 HannaPunchBlock ALTK-CBM

Lamellar Surgery

lamellarsurgeryAs the exclusive distributor for MORIA in Canada, I-MED Surgical offers a full range of devices to perfrom lamellar surgery.

  • Descemets' Stripping Automated Endothelial Keratoplasty (DSAEK) for Fuchs' and other endothelial dystrophies (i.e. posterior polymorphous dystrophy), post-cataract surgery edema (aphakic or pseudophakic bullous keratopathy) and some of failed PK.
  • Superficial Anterior Lamellar Keratoplasty (SALK) indicated in the treatment of superficial corneal opacities resulting from previous refractive surgical procedures, infections, degenerations, dystrophies, superficial scars or trauma. 
  • Deep Anterior Lamellar Keratoplasty (DALK) indicated when a thicker stromal lamella should be removed: keratoconus, post-herpetic scars, post-infectious opacities, some corneal dystrophies, and alkali or acid burn lesions. 
  • Mushroom and Lap joint Keratoplasty indicated in patients with full-thickness central stromal opacities but normal endothelium.

Advantages of DSAEK

• Stronger wound, resistant to trauma.
• Astigmatically neutral.
• Corneal nerves preserved.
• Faster rehabilitation with vision comparable to PK.
• No suture related complications.

Visual acuity: DSAEK has the best visual recovery, as early as 6 weeks post-op

DiapoDSAEK1

For more information about our lamellar surgery equipment please contact us.

Surgical Technique

DSAEK Indications

• Fuch’s and other endothelial dystrophies (i.e. posterior polymorphous dystrophy).
• Post-cataract surgery edema (aphakic or pseudophakic bullous keratopathy).
• Some of failed Penetrating Keratoplasty.

Surgical Techniques

The surgical DSAEK technique is now well established but can slightly vary surgeon to surgeon.

The basic procedure is as follows:

1. Donor cornea preparation with the Moria artificial chamber and the CBm microkeratome,
2. Preparation of recipient cornea and Descemet’s membrane stripping,
3. Donor lamellar insertion, positioning and adherence.

DSAEKprocedurebrochure

DSAEK Procedure Brochure

Scientific Publications

Preventing graft dislocation is key to good outcome
Eyeworld, May 2008 by David T. Vroman, MD

Graft dislocation, a complication of Descemet's Stripping Automated Endothelial Keratoplasty may be more common using precut tissue. Many surgeons are now choosing to perform DSAEK rather than PK to treat patient with corneal endothelial disease.  DSAEK has indeed many advantages over full-thickness corneal transplantation: rapid visual recovery, less induced astigmatisc and spherical refractive error. 

The key decision concern the donor tissue; according to Dr. Vroman (Charleston, SC), the use of precut tissue (thicker, harder to mark...) has resulted in more refractive errors.

DSEK upsurge to high satisfaction, good visual results
Ophthalmology Times, Sept. 15, 2007 by Francis W. Price, MD

"Descemet’s Stripping Endothelial Keratoplasty (DSEK) has changed the landscape in cornea surgery. Compared with those who have undergone penetrating keratoplasty. DSEK patients have an easier time postoperatively with rapid visual recovery."

Descemet's stripping endothelial keratoplasty
Current Opinion in Ophthalmology, Jul. 2007 by Marianne O. Price and Francis W. Price, MD

"Descemet's stripping endothelial keratoplasty is rapidly becoming the preferred treatment for corneal endothelial dysfunction. Familiarity with recent advances in techniques and instrumentation can help reduce the initially steep learning curve and incidence of complications.

DSEK produces excellent visual outcomes with minimal change in corneal surface topography or refraction. It can successfully treat corneal dysfunction associated with Fuchs' endothelial dystrophy, bullous keratopathy, iridocorneal endothelial syndrome or a failed penetrating graft. Donor dissection has become automated, and new techniques have been devised to facilitate graft insertion and unfolding. Some surgeons now routinely perform DSEK with topical anesthesia. Graft detachment is the most frequent early postoperative complication, but new methods can help promote donor adherence. The incidence of graft-rejection episodes is lower after DSEK compared with standard penetrating keratoplasty, possibly because wound healing is a lesser concern, and many DSEK patients are maintained on low-dose topical steroids indefinitely. Early efforts to transplant just the endothelial cell layer show promise."