Turkiye Klinikleri Journal of Ophthalmology

.: REVIEW
Endotelyal Keratoplasti
Endothelial Keratoplasty
Mustafa KOÇa
aGöz Hastalıkları Kliniği, Ulucanlar Göz Eğitim ve Araştırma Hastanesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(1):52-63
doi: 10.5336/ophthal.2017-59290
Article Language: TR
Full Text
ÖZET
 Keratoplasti gerektiren kornea problemlerinde lameller keratoplasti uygulamaları tüm dünyada sürekli artmaktadır. Gelişmiş ülkelerde lameller keratoplasti sayısı penetran keratoplasti (PK) sayısını geçmiştir. Lameller keratoplastiler başlıca iki gruba ayrılmaktadır. Bunlar; stromal dokuların değiştirildiği anterior lameller keratoplasti ve Descemet membranı/endotel kompleksinin değiştirildiği endotelyal keratoplastilerdir (EK). Fuch's endotelyal korneal distrofi ve büllöz keratopati gibi endotel fonksiyonunun bozuk olduğu durumlar başlıca EK endikasyonlarıdır. Endotelyal keratoplastiler ise kendi içinde Descemet Stripping Automatized Endothelial Keratoplasty (DSAEK) ve Descemet Membrane Endothelial Keratoplasty DMEK olarak iki gruba ayrılmaktadır. Bu iki yöntemin amacı ortak olsa da cerrahi yöntemler ve sonuçlar birbirinden farklıdır. DMEK'te görme keskinliği ve refraktif sonuçlar daha iyi, rejeksiyon oranları da daha düşüktür. Ancak uygulanması DSAEK'e göre daha zordur. DSAEK'in ise uygulaması kolaydır, ancak pahalı ekipman gerektirmektedir. Ancak her iki yöntemin de PK'ye ciddi üstünlükleri mevcuttur. Öncelikle EK küçük keşiden yapılmakta ve "open-sky" ilişkili komplikasyon beklenmemektedir. Hastaların çoğu birkaç hafta içerisinde final görmeye ulaşmaktadır. Korneanın orijinal şekli ve sinirleri korunduğundan, ciddi bir kırma kusuru ve nörotrofik problemler beklenmemektedir. Rejeksiyon olasılığı çok daha düşüktür. Sütür ve steroid kullanımıyla ilişkili problemler daha az görülmektedir. Kombine keratoplasti ve katarakt cerrahilerinde biyometrik sapma minimaldir. Endotel hücre kaybı PK ile karşılaştırılabilir düzeydedir. En sık görülen komplikasyonları greft dislokasyonu/dekolmanı olup çoğunlukla ön kamaraya tekrarlanan hava ya da gaz enjeksiyonları ile düzeltilebilmektedir. Bu çalışmada, EK hakkında güncel bilgileri özetlenerek sunulması amaçlanmıştır.

Anahtar Kelimeler: Endotelyum, kornea; kornea nakli
ABSTRACT
 Application of lamellar keratoplasty for corneal problems requiring keratoplasty is constantly increasing all over the world. Lamellar keratoplasty numbers have exceeded penetrating keratoplasty (PK) in developed countries. Lamellar keratoplasties are divided into two main groups: anterior lamellar keratoplasty where the stroma is replaced and endothelial keratoplasty (EK) where the descemet membrane/endothelial complex is replaced. The diseases with impaired endothelial function such as Fuch's endothelial corneal dystrophy and bullous keratopathy are the main indications for EK. Endothelial keratoplasties are divided into two groups as Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK). Although these two methods have common aims, the surgical methods and results are different. Visual acuity and refractive results are better and rejection rates are lower in DMEK. However, it is more difficult technically. DSAEK is easier technically but requires expensive equipment. However, both methods have important advantages over PK. Firstly, EK is performed through small incision and open-sky related complications are not expected. Most of the patients reach the final visual acuity within a few weeks. Since the original shape of cornea and nerves are protected, serious refractive error and neurotrophic problems are not expected. Rejection probability is much lower than PK. Problems associated with suture and steroid use are less common. Biometric deviation is minimal in combined keratoplasty and cataract surgeries. Endothelial cell loss is comparable to PK. The most common complication is graft dislocation/deteachment which can often be treated by air injections into the anterior chamber. The aim of this review is to present current information about the EK.

Keywords: Endothelium, cornea; corneal transplantation
REFERENCES:
  1. Arenas E, Esquenazi S, Anwar M, Terry M. Lamellar corneal transplantation. Surv Ophthalmol. 2012;57(6):510-29. [Crossref] [PubMed]
  2. Anwar M, Teichmann KD. Big-bubble technique to bare Descemet?s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg. 2002;28(3):398-403. [Crossref]
  3. Tillett CW. Posterior lamellar keratoplasty. Am J Ophthalmol. 1956;41(3):530-3. [Crossref]
  4. Melles GR, Lander F, Nieuwendaal C. Sutureless, posterior lamellar keratoplasty: a case report of a modified technique. Cornea. 2002;21(3):325-7. [Crossref] [PubMed]
  5. Terry MA. Deep lamellar endothelial keratoplasty (DLEK): pursuing the ideal goals of endothelial replacement. Eye (Lond). 2003;17(8):982-8. [Crossref] [PubMed]
  6. Price FW Jr, Price MO. Descemet?s stripping with endothelial keratoplasty in 200 eyes: early challenges and technique to enhance donor adherence. J Cataract Refract Surg. 2006; 32(3):411-8. [Crossref] [PubMed]
  7. Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25(8): 886-9. [Crossref] [PubMed]
  8. Melles GR, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25(8): 987-90. [Crossref]
  9. Eye banking statistical Reports 2015, available from the Eye Bank Association of America. [Link]
  10. Bozkurt TK, Acar B, Kilavuzoglu AE, Akdemir MO, Hamilton DR, Cosar Yurteri CB, et al. An 11-year review of keratoplasty in a tertiary referral center in Turkey: changing surgical techniques for similar indications. Eye Contact Lens. 2016;43(6):364-70. [Crossref] [PubMed]
  11. Acar BT, Acar TS. [Descemet stripping automated endothelial keratoplasty for treatment of pseudophakic bullous keratopathy]. Turk J Ophthalmol. 2012;42(4):263-8.
  12. Veldman PB, Terry MA, Straiko MD. Evolving indications for Descemet?s stripping automated endothelial keratoplasty. Curr Opin Ophthalmol. 2014;25(4):306-11. [Crossref] [PubMed]
  13. Patel SV, Baratz KH, Maguire LJ, Hodge DO, McLaren JW. Anterior corneal aberrations after Descemet?s stripping endothelial keratoplasty for Fuchs? endothelial dystrophy. Ophthalmology. 2012;119(8):1522-9. [Crossref] [PubMed]
  14. Patel SV, McLaren JW. In vivo confocal microscopy of Fuchs endothelial dystrophy before and after endothelial keratoplasty. JAMA Ophthalmol. 2013;131(5):611-8. [Crossref] [PubMed]
  15. Güell JL, Morral M, Gris O, Elies D, Manero F. Bimanual technique for insertion and positioning of endothelium-Descemet membrane graft in Descemet membrane endothelial keratoplasty. Cornea. 2013;32(12):1521-6. [Crossref] [PubMed]
  16. Chaurasia S, Price FW Jr, Gunderson L, Price MO. Descemet?s membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery). Ophthalmology. 2014;121(2):454-8. [Crossref] [PubMed]
  17. Melles GR, Wijdh RH, Nieuwendaal CP. A technique to excise the descemet membrane from a recipient cornea (descemetorhexis). Cornea. 2004;23(3):286-8. [Crossref] [PubMed]
  18. Tourtas T, Schlomberg J, Wessel JM, Bachmann BO, Schlötzer-Schrehardt U, Kruse FE. Graft adhesion in descemet membrane endothelial keratoplasty dependent on size of removal of host?s descemet membrane. JAMA Ophthalmol. 2014;132(2):155-61. [Crossref] [PubMed]
  19. Gonzalez A, Price FW Jr, Price MO, Feng MT. Prevention and management of pupil block after Descemet membrane endothelial keratoplasty. Cornea. 2016;35(11):1391-5. [Crossref] [PubMed]
  20. Hamzaoglu EC, Straiko MD, Mayko ZM, Sáles CS, Terry MA. The first 100 eyes of standardized Descemet stripping automated endothelial keratoplasty versus standardized Descemet membrane endothelial keratoplasty. Ophthalmology. 2015;122(11):2193-9. [Crossref] [PubMed]
  21. Stanzel TP, Ersoy L, Sansanayudh W, Felsch M, Dietlein T, Bachmann B, et al. Immediate postoperative intraocular pressure changes after anterior chamber air fill in Descemet membrane endothelial keratoplasty. Cornea. 2016;35(1):14-9. [Crossref] [PubMed]
  22. Villarrubia A, Cano-Ortiz A. Development of a nomogram to achieve ultrathin donor corneal disks for Descemet stripping automated endothelial keratoplasty. J Cataract Refract Surg. 2015;41(1):146-51. [Crossref] [PubMed]
  23. Dickman MM, Kruit PJ, Remeijer L, van Rooij J, Van der Lelij A, Wijdh RH, et al. A randomized multicenter clinical trial of ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) versus DSAEK. Ophthalmology. 2016;123(11):2276-84. [Crossref] [PubMed]
  24. Khan SN, Shiakolas PS, Mootha VV. Descemet?s stripping automated endothelial keratoplasty tissue insertion devices. J Ophthalmic Vis Res. 2015;10(4):461-8. [Crossref] [PubMed] [PMC ]
  25. Lie JT, Birbal R, Ham L, van der Wees J, Melles GR. Donor tissue preparation for Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2008;34(9):1578-83. [Crossref] [PubMed]
  26. Groeneveld-van Beek EA, Lie JT, van der Wees J, Bruinsma M, Melles GR. Standardized ?no-touch? donor tissue preparation for DALK and DMEK: harvesting undamaged anterior and posterior transplants from the same donor cornea. Acta Ophthalmol. 2013;91(2): 145-50. [Crossref ] [PubMed]
  27. Cabot F, Kankariya VP, Ruggeri M, Yoo SH, Vaddavalli PK, Parel JM, et al. High-resolution optical coherence tomography-guided donor tissue preparation for descemet membrane endothelial keratoplasty using the reverse big bubble technique. Cornea. 2014;33(4):428-31. [Crossref] [PubMed] [PMC]
  28. McKee HD, Irion LC, Carley FM, Jhanji V, Brahma AK. Donor preparation using pneumatic dissection in endothelial keratoplasty: DMEK or DSEK? Cornea. 2012;31(7):798800. [Crossref] [PubMed]
  29. Parekh M, Ruzza A, Salvalaio G, Ferrari S, Camposampiero D, Busin M, et al. Descemet membrane endothelial keratoplasty tissue preparation from donor corneas using a standardized submerged hydro-separation method. Am J Ophthalmol. 2014;158(2):27785.e1. [Crossref] [PubMed]
  30. Heinzelmann S, Hüther S, Böhringer D, Eberwein P, Reinhard T, Maier P. Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea. 2014;33(6): 644-8. [Crossref] [PubMed]
  31. Thaler S, Hofmann J, Bartz-Schmidt KU, Schuettauf F, Haritoglou C, Yoeruek E. Methyl blue and aniline blue versus patent blue and trypan blue as vital dyes in cataract surgery: capsule staining properties and cytotoxicity to human cultured corneal endothelial cells. J Cataract Refract Surg. 2011;37(6):1147-53. [Crossref] [PubMed]
  32. Guerra FP, Anshu A, Price MO, Giebel AW, Price FW. Descemet?s membrane endothelial keratoplasty prospective study of 1-year visual outcomes, graft survival, and endot-helial cell loss. Ophthalmology. 2011; 118(12):2368-73. [Crossref] [PubMed]
  33. Terry MA, Straiko MD, Veldman PB, Talajic JC, VanZyl C, Sales CS, et al. Standardized DMEK technique: reducing complications using prestripped tissue, novel glass injector, and sulfur hexafluoride (SF6) gas. Cornea. 2015;34(8):845-52. [Crossref] [PubMed]
  34. Monnereau C, Quilendrino R, Dapena I, Liarakos VS, Alfonso JF, Arnalich-Montiel F, et al. Multicenter study of descemet membrane endothelial keratoplasty: first case series of 18 surgeons. JAMA Ophthalmol. 2014;132(10):1192-8. [Crossref] [PubMed]
  35. Kruse FE, Laaser K, Cursiefen C, Heindl LM, Schlötzer-Schrehardt U, Riss S, et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30(5):580-7. [Crossref] [PubMed]
  36. Bachmann BO, Laaser K, Cursiefen C, Kruse FE. A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2010;149(6):922-5.e2. [Crossref] [PubMed]
  37. Liarakos VS, Dapena I, Ham L, van Dijk K, Melles GR. Intraocular graft unfolding techniques in descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 2013;131(1): 29-35. [Crossref] [PubMed]
  38. Steven P, Le Blanc C, Velten K, Lankenau E, Krug M, Oelckers S, et al. Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol. 2013;131(9):113542. [Crossref] [PubMed]
  39. Anshu A, Price MO, Tan DT, Price FW Jr. Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol. 2012;57(3):23652. [Crossref] [PubMed]
  40. Ang M, Wilkins MR, Mehta JS, Tan D. Descemet membrane endothelial keratoplasty. Br J Ophthalmol. 2016;100(1):15-21. [Crossref] [PubMed]
  41. Jun B, Kuo AN, Afshari NA, Carlson AN, Kim T. Refractive change after descemet stripping automated endothelial keratoplasty surgery and its correlation with graft thickness and diameter. Cornea. 2009;28(1):19-23. [Crossref] [PubMed]
  42. Holz HA, Meyer JJ, Espandar L, Tabin GC, Mifflin MD, Moshirfar M. Corneal profile analysis after Descemet?s stripping endothelial keratoplasty and its relationship to postoperative hyperopic shift. J Cataract Refract Surg. 2008;34(2):211-4. [Crossref] [PubMed]
  43. Nanavaty MA, Wang X, Shortt AJ. Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev. 2014;14(2):CD008420. [Crossref]
  44. Price FW Jr, Feng MT, Price MO. Evolution of endothelial keratoplasty: where are we headed? Cornea. 2015;34 Suppl 10:S41-7. [Crossref] [PubMed]
  45. Anshu A, Price MO, Price FW Jr. Descemet?s stripping endothelial keratoplasty under failed penetrating keratoplasty: visual rehabilitation and graft survival rate. Ophthalmology. 2011;118(11):2155-60. [Crossref] [PubMed]
  46. Haddadin RI, Chodosh J. Corneal transplantation and glaucoma. Semin Ophthalmol. 2014;29(5-6):380-96. [Crossref] [PubMed]
  47. Oie Y, Nishida K. Triple procedure: cataract extraction, intraocular lens implantation, and corneal graft. Curr Opin Ophthalmol. 2017;28(1):63-6. [Crossref] [PubMed]
  48. Kosker M, Suri K, Duman F, Hammersmith KM, Nagra PK, Rapuano CJ. Long-term outcomes of penetrating keratoplasty and Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy: fellow eye comparison. Cornea. 2013;32(8):1083-8. [Crossref] [PubMed]
  49. Greenrod EB, Jones MN, Kaye S, Larkin DF; National Health Service Blood and Transplant Ocular Tissue Advisory Group and Contributing Ophthalmologists (Ocular Tissue Advisory Group Audit Study 16). Center and surgeon effect on outcomes of endothelial keratoplasty versus penetrating keratoplasty in the United Kingdom. Am J Ophthalmol. 2014;158(5):95766. [Crossref] [PubMed]
  50. 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): 1382-6. [Crossref] [PubMed]
  51. Li JY, Terry MA, Goshe J, Davis-Boozer D, Shamie N. Three-year visual acuity outcomes after Descemet?s stripping automated endothelial keratoplasty. Ophthalmology. 2012;119(6):1126-9. [Crossref] [PubMed]
  52. Patel SV, Baratz KH, Hodge DO, Maguire LJ, McLaren JW. The effect of corneal light scatter on vision after descemet stripping with endothelial keratoplasty. Arch Ophthalmol. 2009;127(2):153-60. [Crossref] [PubMed]
  53. Hindman HB, Huxlin KR, Pantanelli SM, Callan CL, Sabesan R, Ching SS, et al. PostDSAEK optical changes: a comprehensive prospective analysis on the role of ocular wavefront aberrations, haze and corneal thickness. Cornea. 2013;32(12):1567-77. [Crossref] [PubMed] [PMC]
  54. Morishige N, Yamada N, Teranishi S, Chikama T, Nishida T, Takahara A. Detection of subepithelial fibrosis associated with corneal stromal edema by second harmonic generation imaging microscopy. Invest Ophthalmol Vis Sci. 2009;50(7):3145-50. [Crossref] [PubMed]
  55. Morishige N, Chikama T, Yamada N, Takahashi N, Morita Y, Nishida T, et al. Effect of preoperative duration of stromal oedema in bullous keratopathy on early visual acuity after endothelial keratoplasty. J Cataract Refract Surg. 2012;38(2):303-8. [Crossref] [PubMed]
  56. Morishige N, Yamada N, Morita Y, Kimura K, Sonoda KH. Persistence of structural changes at the anterior cornea in bullous keratopathy patients after endothelial keratoplasty. PLoS One. 2013;8(9):e74279. [Crossref] [PubMed] [PMC]
  57. McLaren JW, Patel SV. Modeling the effect of forward scatter and aberrations on visual acuity after endothelial keratoplasty. Invest Oph thalmol Vis Sci. 2012;53(9):5545-51. [Crossref] [PubMed]
  58. Chamberlain W, Omid N, Lin A, Farid M, Gaster RN, Steinert RF. Comparison of corneal surface higher-order aberrations after endothelial keratoplasty, femtosecond laserassisted keratoplasty, and conventional penetrating keratoplasty. Cornea. 2011;31(1): 6-13. [Crossref] [PubMed]
  59. Rudolph M, Laaser K, Bachman BO, Cursiefen C, Epstein D, Kruse FE. Corneal higher-order aberrations after Descemet?s membrane endothelial keratoplasty. Ophthalmology. 2012;119(3):528-35. [Crossref] [PubMed]
  60. Faia LJ, Baratz KH, Bourne WM. Corneal graft folds: a complication of deep lamellar endothelial keratoplasty. Arch Ophthalmol. 2006;124(4):593-5. [Crossref] [PubMed]
  61. Seery LS, Nau CB, McLaren JW, Baratz KH, Patel SV. Graft thickness, graft folds, and aberrations after Descemet stripping endothelial keratoplasty for Fuchs dystrophy. Am J Ophthalmol. 2011;152(6):910-6. [Crossref] [PubMed] [PMC]
  62. Van Cleynenbreugel H, Remeijer L, Hillenaar T. Descemet stripping automated endothelial keratoplasty: effect of intraoperative lenticule thickness on visual outcome and endothelial cell density. Cornea. 2011;30(11):1195-200. [Crossref] [PubMed]
  63. Shinton AJ, Tsatsos M, Konstantopoulos A, Goverdhan S, Elsahn AF, Anderson DF, et al. Impact of graft thickness on visual acuity after Descemet?s stripping endothelial keratoplasty. Br J Ophthalmol. 2012;96(2):246-9. [Crossref] [PubMed]
  64. Rice A, Spokes DM, Anand S, Ball JL. Analysis in Descemet stripping endothelial keratoplasty. Cornea. 2011;30(8):865-71. [Crossref] [PubMed]
  65. Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea. 2011;30(4):388-91. [Crossref] [PubMed]
  66. Dickmann MM, Cheng YY, Berendschot TT, van den Biggelaar FJ, Nuijts RM. Effects of graft thickness and asymmetry on visual gain and aberrations after descemet stripping automated endothelial keratoplasty. JAMA Ophthalmol. 2013;131(6):737-44. [Crossref] [PubMed]
  67. Busin M, Albé E. Does thickness matter: ultrathin Descemet stripping automated endothelial keratoplasty. Curr Opin Ophthalmol. 2014;25(4):312-8. [Crossref] [PubMed]
  68. Turnbull AM, Tsatsos M, Hossain PN, Anderson DF. Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol. 2016;61(3):25-71.[Crossref] [PubMed]
  69. Mehta JS, Shilbayeh R, Por YM, CajucomUy H, Beuerman RW, Tan DT. Femtosecond laser creation of donor cornea buttons for Descemet-stripping endothelial keratoplasty. J Cataract Refract Surg. 2008;34(11):1970-5. [Crossref] [PubMed]
  70. Cheng YY, Schouten JS, Tahzib NG, Wijdh RJ, Pels E, van Cleynenbreugel H, et al. Efficacy and safety of femtosecond laser-assisted corneal endothelial keratoplasty: a randomized multicenter clinical trial. Transplantation. 2009;88(11):1294-302. [Crossref] [PubMed]
  71. Tourtas T, Laaser K, Bachmann BO, Cursiefen C, Kruse FE. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2012;153(6):1082-90.e2. [Crossref] [PubMed]
  72. Goldich Y, Showail M, Avni-Zauberman N, Perez M, Ulate R, Elbaz U, et al. Contralateral eye comparison of descemet membrane endothelial keratoplasty and descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2015;159(6):155-9e1.
  73. Price MO, Price FW Jr. Endothelial keratoplasty-a review. Clin Exp Ophthalmol. 2010;38(2):128-40. [Crossref] [PubMed]
  74. 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):2361-8. [Crossref] [PubMed]
  75. Baydoun L, Tong CM, Tse WW, Chi H, Parker J, Ham L, et al. Endothelial cell density after descemet membrane endothelial keratoplasty: 1 to 5-year follow-up. Am J Ophthalmol. 2012;154(4):762-3. [Crossref] [PubMed]
  76. Feng MT, Price MO, Miller JM, Price FW Jr. Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up. J Cataract Refract Surg. 2014;40(7):1116-21. [Crossref] [PubMed]
  77. Price MO, Fairchild KM, Price DA, Price FW Jr. Descemet?s stripping endothelial keratoplasty five-year graft survival and endothelial cell loss. Ophthalmology. 2011;118(4):725-9. [Crossref] [PubMed]
  78. Ratanasit A, Gorovoy MS. Long-term results of Descemet stripping automated endothelial keratoplasty. Cornea. 2011;30(12):1414-8. [Crossref] [PubMed]
  79. Lass JH, Gal RL, Dontchev M, Beck RW, Kollman C, Dunn SP, et al; Cornea Donor Study Investigator Group. Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation. Specular microscopy ancillary study results. Ophthalmology. 2008;115(4):627-32.e8. [Crossref] [PubMed] [PMC]
  80. Baydoun L, Müller T, Lavy I, Parker J, Rodriguez-Calvo-de-Mora M, Liarakos VS, et al. Ten-year clinical outcome of the first patient undergoing Descemet membrane endothelial keratoplasty. Cornea. 2017;36(3):379-81. [PubMed]
  81. Anshu A, Price MO, Price FW Jr. Risk of corneal transplant rejection significantly reduced with Descemet?s membrane endothelial keratoplasty. Ophthalmology. 2012;119(3): 536-40. [Crossref] [PubMed]
  82. Hjortdal J, Pedersen IB, Bak-Nielsen S, Ivarsen A. Graft rejection and graft failure after penetrating keratoplasty or posterior lamellar keratoplasty for fuchs endothelial dystrophy. Cornea. 2013;32(5):e60-3. [Crossref] [PubMed]
  83. Suh LH, Yoo SH, Deobhakta A, Donaldson KE, Alfonso EC, Culbertson WW, et al. Complications of Descemet?s stripping with automated endothelial keratoplasty: survey of 118 eyes at one institute. Ophthalmology. 2008;115(9):1517-24. [Crossref] [PubMed]
  84. Price MO, Price FW Jr. Endothelial cell loss after Descemet stripping with endothelial keratoplasty: influencing factors and 2-year trend. Ophthalmology. 2008;115(5):857-65. [Crossref] [PubMed]
  85. Terry MA, Shamie N, Chen ES, Hoar KL, Friend DJ. Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. Ophthalmology. 2008;115(7):1179-86. [Crossref] [PubMed]
  86. Melles GR, Ong TS, Ververs B, van der Wees J. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2008;145(2):222-7. [Crossref] [PubMed]
  87. Goshe JM, Terry MA, Li JY, Straiko MD, Davis-Boozer D. Graft dislocation and hypotony after Descemet?s stripping automated endothelial keratoplasty in patients with previous glaucoma surgery. Ophthalmology. 2012;119(6):1130-3. [Crossref] [PubMed]
  88. Quek DT, Wong T, Tan D, Mehta JS. Corneal graft survival and intraocular pressure control after descemet stripping automated endothelial keratoplasty in eyes with pre-existing glaucoma. Am J Ophthalmol. 2011;152(1):48-54. e2.
  89. Baydoun L, van Dijk K, Dapena I, Musa FU, Liarakos VS, Ham L, et al. Repeat Descemet membrane endothelial keratoplasty after complicated primary descemet membrane endothelial keratoplasty. Ophthalmology. 2015;122(1):8-16. [Crossref] [PubMed]
  90. Acar BT, Muftuoglu O, Acar S. Comparison of sulfur hexafluoride and air for donor attachment in Descemet stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy. Cornea. 2014;33(3):219-22. [Crossref] [PubMed]
  91. Botsford B, Vedana G, Cope L, Yiu SC, Jun AS. Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK). Arq Bras Oftalmol. 2016;79(5):299-302. [Crossref] [PubMed]
  92. Jordan CS, Price MO, Trespalacios R, Price FW Jr. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms. Br J Ophthalmol. 2009;93(3):387-90. [Crossref] [PubMed]
  93. Bahar I, Kaiserman I, McAllum P, Slomovic A, Rootman D. Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology. 2008;115(9):1525-33. [Crossref] [PubMed]
  94. Monnereau C, Bruinsma M, Ham L, Baydoun L, Oellerich S, Melles GR. Endothelial cell changes as an indicator for upcoming allograft rejection following descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2014;158(3):485-95. [Crossref] [PubMed]
  95. Henein C, Nanavaty MA. Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye. 2017;40(1):3-14. [Crossref] [PubMed]
  96. Dapena I, Ham L, Netuková M, van der Wees J, Melles GR. Incidence of early allograft rejection after Descemet membrane endothelial keratoplasty. Cornea. 2011; 30(12):1341-5. [Crossref] [PubMed]
  97. Meekins LC, Rosado-Adames N, Maddala R, Zhao JJ, Rao PV, Afshari NA. Corneal endothelial cell migration and proliferation enhanced by Rho kinase (ROCK) inhibitors in in vitro and in vivo models. Invest Ophthalmol Vis Sci. 2016;57(15):6731-8. [Crossref] [PubMed] [PMC]
  98. Koizumi N, Okumura N, Ueno M, Kinoshita S. New therapeutic modality for corneal endothelial disease using Rho-associated kinase inhibitor eye drops. Cornea. 2014;33 Suppl 11:S25-31. [Crossref] [PubMed]
  99. Wang TJ, Wang IJ, Hu FR, Young TH. Applications of biomaterials in corneal endothelial tissue engineering. Cornea. 2016;35 Suppl:S25-S30. [Crossref] [PubMed]

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com