By Michael Szkarlat, Partner Development Director
Oct. 25, 2022 — We were joined by Dr. Daniel Montenegro of the Eye Centers of South Florida for our October 2022 webinar. Dr. Montenegro led a data-focused walk-through of the considerations for performing DSAEK transplants in eyes with concurrent glaucoma.
Dr. Montenegro begins with a discussion about how increased endothelial cell loss (ECL) in patients with glaucoma drainage devices (GDD) or other previous glaucoma surgeries leads to earlier than normal graft failure. He does a quick review of the proposed mechanisms for this ECL before diving into some research on the topic and a discussion of the U.S. Food and Drug Administration’s role in monitoring these glaucoma devices.
Dr. Montenegro then does an overview of why DSAEK is preferrable in these eyes when compared to more conventional PKP along with a brief history of advances in EK surgery over the last 20+ years. Going back to the research, he dives further into the protein composition of aqueous humor in eyes with GDD and how this relates to ECL in these eyes. He also touches on the positioning of the GDD as it relates to graft failure rates in PKP.
Up next is a case report of a DSAEK transplant for endothelial decompensation following a trabeculectomy in an eye with severe edema resulting in a very limited view into the anterior chamber. Dr. Montenegro shows photos and describes each step of the surgery along with the reasoning for his approach. We are then taken back to the research once again looking at graft survival for the first vs. second DSAEK transplants in eyes with Ahmed valve implants.
Dr. Montenegro wraps up the webinar with an in-depth review of the advantages of DSAEK vs. PKP for these patients along with the challenges that these cases present. He then reviews some of the potential future treatments for endothelial cell dysfunction before summarizing some of the take home messages from the presentation. This is then followed by a lively question and answer discussion from the audience!
Key takeaways include:
Eversight's free webinars are a great way for you to connect, learn and train digitally with leading ophthalmologists and researchers from around the world. We invite you to RSVP for scheduled webinars and browse our recording library.
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About the author
Michael Szkarlat, Partner Development Director
Michael has been with Eversight since 2016 and has recently worked to develop Eversight's educational wet lab programs for EK surgery and a standardized protocol for DALK practice in a wet lab setting. His eye banking experience is rooted in the preparation of corneal grafts and spent nearly five years as Eversight’s Medical Director designee in charge of training clinical team members to prepare corneal tissue for DMEK and DSAEK surgery. In his time at Eversight, Michael has presented at scientific conferences, been involved in clinical research and developed innovations in tissue processing. He was named an IAPB Eye Heath Hero in the innovations category. Michael is passionate about community-based eye banking and honoring the precious gift that is donation. When not at work, he enjoys traveling with his wife and baking artisan sourdough bread.
