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Gas-Graft Coverage After DMEK: A Clinically Validated Numeric Study.

Jan O Pralits¹, Mark Alberti², Javier Cabreizo^2,3

¹Department of Civil, Chemical and Environmental Engineering, University of Genoa, Italy.

Translational Vision Science & Technology

|November 19, 2019

Summary

This summary is machine-generated.

Gas fill is key for graft coverage in phakic eyes during Descemet membrane endothelial keratoplasty (DMEK). In pseudophakic eyes, both gas fill and patient positioning significantly impact graft coverage, especially with greater anterior chamber depth.

Keywords:

DMEK endothelial keratoplasty intraocular gas numeric model patient positioning

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Area of Science:

Ophthalmology
Biomedical Engineering
Mathematical Modeling

Background:

Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure to restore vision by replacing damaged endothelial cells.
Achieving optimal graft coverage is crucial for successful DMEK outcomes.
Bubble configuration and graft adherence are influenced by intraocular factors and surgical techniques.

Purpose of the Study:

To investigate how patient positioning, gas fill volume, and anterior chamber size affect bubble configuration and graft coverage in DMEK.
To develop and validate a mathematical model for predicting graft coverage in DMEK.
To provide clinically relevant insights into optimizing DMEK surgical parameters.

Main Methods:

A mathematical model was developed to simulate bubble dynamics and graft coverage in eyes with varying anterior chamber depths (ACD).
Governing equations were solved numerically using OpenFOAM, an open-source computational fluid dynamics software.
Numerical results were clinically validated to correlate gas fill with graft coverage.

Main Results:

In phakic eyes (ACD = 2.65 mm), 70% gas fill significantly increased graft coverage (85-92%) compared to 35% fill (35-38%).
In pseudophakic eyes (ACD = 4.35 mm), graft coverage with 35% fill ranged from 8-52%, increasing to 63-94% with 70% fill, with positioning playing a larger role.
The model showed negligible differences between air and SF6, and identified thin aqueous humor patches within gas bubbles in some cases.

Conclusions:

Graft coverage in phakic eyes is primarily determined by gas fill, with positioning having minimal impact.
In pseudophakic eyes, graft coverage is dependent on both gas fill and patient positioning, with positioning becoming more critical as ACD increases.
Anterior chamber depth significantly modulates the effect of patient positioning on gas bubble behavior and graft coverage post-DMEK.