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

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          Abstract

          Purpose

          We investigate the influence of positioning, gas fill, and anterior chamber size on bubble configuration and graft coverage after Descemet's membrane endothelial keratoplasty (DMEK).

          Methods

          We use a mathematical model to study the bubble shape and graft coverage in eyes of varying anterior chamber depths (ACD). The governing equations are solved numericly using the open source software OpenFOAM. Numeric results are validated clinically so that clinical gas fill measures can be correlated with numeric results providing gas-graft coverage information otherwise clinically inaccessible.

          Results

          In a phakic eye (ACD = 2.65 mm) with a gas fill of 35%, graft contact ranged from 35% to 38% depending on positioning and increased to 85% to 92% with a 70% fill. In contrast, positioning of a pseudophakic eye (ACD = 4.35) with a gas fill of 35% results in graft contact ranging from 8% to 52%, increasing to 63% to 94% with a 70% fill. The mathematical model demonstrates negligible differences between air and SF6 results and interestingly, a very thin central patch of aqueous humor within the gas bubble is found in some cases.

          Conclusions

          Graft coverage in phakic eyes (ACD ≤ 3 mm) is dominated by the gas fill and less sensitive to patient positioning. In pseudophakic eyes with larger values of ACD, the graft coverage depends on gas fill and patient positioning with positioning even more important as ACD increases.

          Translational Relevance

          Anterior chamber depth markedly influences the role of patient positioning in gas-filled eyes after DMEK due to the interplay between anterior chamber anatomy and gas bubble morphology.

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          Most cited references19

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          Evaluating the performance of the two-phase flow solver interFoam

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            Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

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              Comparison of Sulfur Hexafluoride 20% versus Air Tamponade in Descemet Membrane Endothelial Keratoplasty.

              To compare clinical outcomes using 20% sulfur hexafluoride (SF6) versus 100% air as a tamponade for graft attachment in Descemet membrane endothelial keratoplasty (DMEK).
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                Author and article information

                Journal
                Transl Vis Sci Technol
                Transl Vis Sci Technol
                tvst
                Transl Vis Sci Technol
                TVST
                Translational Vision Science & Technology
                The Association for Research in Vision and Ophthalmology
                2164-2591
                November 2019
                12 November 2019
                : 8
                : 6
                : 9
                Affiliations
                [1 ]Department of Civil, Chemical and Environmental Engineering, University of Genoa, Italy
                [2 ]Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
                [3 ]Copenhagen Eye Foundation, Copenhagen, Denmark
                Author notes
                Correspondence: Mark Alberti, Department of Ophthalmology, Rigshospitalet – Glostrup, Valdemar Hansen Vej 13, 2600 Glostrup, Denmark. e-mail: markalberti@ 123456gmail.com
                [*]

                JOP and MA contributed equally to this article.

                Article
                tvst-08-05-31 TVST-19-1585
                10.1167/tvst.8.6.9
                6855375
                c87dbcb6-5696-41d5-9424-5286914f3883
                Copyright 2019 The Authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 22 April 2019
                : 1 September 2019
                Categories
                Articles

                endothelial keratoplasty,intraocular gas,patient positioning,numeric model,dmek

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