Graft Adhesion in DMEK

Original Investigation Research

14. Kruse FE, Laaser K, Cursiefen C, et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30(5):580-587. 15. Price FW Jr, Price MO. Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 2005;21(4):339-345. 16. Guerra FP, Anshu A, Price MO, Price FW. Endothelial keratoplasty: fellow eyes comparison of Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Cornea. 2011;30(12):1382-1386. 17. Price MO, Giebel AW, Fairchild KM, Price FW Jr. Descemet’s membrane endothelial keratoplasty:

prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009;116(12):2361-2368. 18. Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GR. Standardized “no-touch” technique for Descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2011;129(1):88-94. 19. Schlötzer-Schrehardt U, Bachmann BO, Laaser K, Cursiefen C, Kruse FE. Characterization of the cleavage plane in Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2011;118(10):1950-1957. 20. Dirisamer M, van Dijk K, Dapena I, et al. Prevention and management of graft detachment in Descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2012;130(3):280-291.

21. Yeh RY, Quilendrino R, Musa FU, Liarakos VS, Dapena I, Melles GR. Predictive value of optical coherence tomography in graft attachment after Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2013;120(2):240-245. 22. Dirisamer M, Dapena I, Ham L, et al. Patterns of corneal endothelialization and corneal clearance after Descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy. Am J Ophthalmol. 2011;152(4):543-555, e1. 23. Jacobi C, Zhivov A, Korbmacher J, et al. Evidence of endothelial cell migration after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2011;152(4):537-542.e2.

OPHTHALMIC IMAGES

Pincushion Sign Richard Peter Gale, MD, FRCOphth; Bertrand Pilly, MD, FEBO; Patrizia Tschuor, MD, FEBO

The “pincushion sign” is a sign of multiple previous intravitreal injections with a small-gauge needle. Treatment is often with an anti–vascular endothelial growth factor or steroid for conditions such as neovascular age-related macular degeneration, diabetic macular edema, or cystoid macular edema secondary to retinal vein occlusion. The dark punctuate appearance situated 3.5 to 4.0 mm behind the limbus represents visible pigment through the sclera (black arrowheads). It should be distinguished from the much larger naturally occurring vascular channels commonly seen (white arrowheads). It is not a universal sign of previous treatment, often only being seen in those with a thin sclera such as in myopia. It is important for ophthalmologists to be aware of this sign (1) as an indicator of previous treatment in those unable to communicate their history, (2) for the possibility of inadvertent zonular damage at the time of injection increasing the chance of complicated cataract surgery, and (3) when choosing an alternative site for surgery involving the sclera.

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