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      ["post_content"]=>
      string(1288) "Corneal Transplantation has undergone several advances over the past 2 decades.  From full thickness penetrating keratoplasty (PK) to Deep Lamellar Endothelial Keratoplasty (DLEK – Dr. Mark Terry), Descemet’s Membrane Endothelial Keratoplasty (DSEK – Drs. Garrett Melles and Frank Price), DSAEK (“A” for Automated – Dr. Mark Gorovoy), Descemet’s Membrane Endothelial Keratoplasty (DMEK – Drs. Garrett Melles and Frank Price) and now, Pre-descemet’s Endothelial Keratoplasty (PDEK – Dr. Amar Agarwal).

https://www.youtube.com/watch?v=NmmOMC-asnc

 

Potential advantages of PDEK, this latest version of endothelial keratoplasty include:

a) ability to use younger donor tissue in comparison to DMEK

b) a more predictable learning curve and procedure (my opinion) over DMEK

c) ability to manipulate a more robust donor tissue (addition of Dua's Layer), particularly when combined with air pump - unlike DMEK

d) potentially more forgiving if there is overlap with residual host Descemet's membrane

e) reduced need for SF6 and fewer re-bubbling procedures in comparison to DMEK

Disadvantages of PDEK

a) tissue preparation learning curve (for surgeon or Eye Bank)

b) donor size is usually a little less than 7mm in diameter[/fusion_text]"
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      string(2724) "Corneal Transplantation has undergone several advances over the past 2 decades.  From full thickness penetrating keratoplasty (PK) to Deep Lamellar Endothelial Keratoplasty (DLEK - Dr. Mark Terry), Descemet's Membrane Endothelial Keratoplasty (DSEK - Drs. Garrett Melles and Frank Price), DSAEK ("A" for Automated - Dr. Mark Gorovoy), Descemet's Membrane Endothelial Keratoplasty (DMEK - Drs. Garrett Melles and Frank Price) and now, Pre-descemet's Endothelial Keratoplasty (PDEK - Dr. Amar Agarwal).

[caption id="attachment_3306" align="alignleft" width="149"] Ashiyana Nariani MD, MPH leads the collaborative effort that brings this procedure to Duke.[/caption]

The goal with PDEK is to offer a procedure that takes the advantages of DSAEK (younger donor tissue, fewer re-operations, shorter surgical learning curve, intraoperative surgical predictability, robust tissue suitable for manipulation) and combine this with the advantages of DMEK (quality of vision, faster recovery rate, lower rate of rejection - however this last feature remains unproven)

Second-year Clinical Associate, Ashiyana Nariani, MD, MPH on the Cornea Service in the Department of Ophthalmology at the Duke Medical Center in Durham, NC has worked tirelessly over the past 2 years to make this transition at Duke a reality.  This began with her visit to Chennai, India to be mentored by Dr. Amar Agarwal the inventor of this procedure, recognizing that the addition of Dua's Layer, 15 microns of tissue between Descemet's membrane and corneal stroma, in combination with an air pump, allowed for a more predictable procedure with younger donor tissue.

Dr. Nariani recognized the advantages of this new procedure and also the potential for the Eye Bank to play this critical role in the preparation of the tissue.  Bring in Miracles in Sight formerly the North Carolina Lions Eye Bank already integral to the Corneal Fellowship Program at Duke.  Well known for their meticulous attention to tissue preparation there has been specific oversight of the PDEK program by their Director of Clinical Services, Isaac L. Perry, BS, MBA, CEBT along with President and CEO, Dean Vavra, MS, CEBT and Vice President of Operations, Mike Trambler.

The DSAEK surgeon will appreciate the ease of transition to a procedure that offers improved quality of vision over DSAEK, while the experienced DMEK surgery will appreciate using younger donor tissue with greater surgical predictability.

https://www.youtube.com/watch?v=X3nbT_r6g_k

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      string(1315) "[youtube id="https://www.youtube.com/watch?v=8F6tz0vrik8&t=9s" width="600" height="350" autoplay="no" api_params="" class=""]Cataract surgery, understandably causes anxiety to anyone needing or considering this procedure.  Patients hear "there is nothing to it" but every patient knows that there are potential problems.  If there were not potential problems, they would not need to undergo and sign an "informed consent."  My patient offers a HIPAA-compliant and Social Media-compliant in-depth analysis of her care at Duke Eye Center in Durham, NC.  In her case, we addressed her pre-existing retinal surgery, high degree of myopia and astigmatism, and her anxiety.  This involved the Femtosecond LenSx LASER, Verion precision, ORA intraoperative wavefront aberommetry confirmation, and a premium toric accommodative intraocular lens.  At Duke, I have the ability to go that extra mile for patients.

 

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https://www.youtube.com/watch?v=NmmOMC-asnc

 

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a) ability to use younger donor tissue in comparison to DMEK

b) a more predictable learning curve and procedure (my opinion) over DMEK

c) ability to manipulate a more robust donor tissue (addition of Dua's Layer), particularly when combined with air pump - unlike DMEK

d) potentially more forgiving if there is overlap with residual host Descemet's membrane

e) reduced need for SF6 and fewer re-bubbling procedures in comparison to DMEK

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Preserving and Restoring Healthy Eyesight.
My Passion and Commitment to You.

alan-carlson-52

Dr. Alan Carlson, MD

Dr. Carlson is one of the most renowned ophthalmologist in the United States and serves as a Professor of Ophthalmology and past Chief of Corneal and Refractive Surgery at Duke University Medical School.  Internationally recognized  as a leading eye surgeon specializing in cataracts, corneal transplantation, eye reconstructive surgery, vision correction and LASIK surgery, as well as Dry Eye treatment, Dr. Carlson’s attention to detail and expertise is why patients from around the world seek out his services. It is also why he is referred by so many optometrist, physicians and eye surgeons in the United States.

Dr. Carlson brings an unparalleled commitment to high quality patient care. If you have complications from eye disease, visual problems or need corrective surgery, contact Dr. Carlson’s office today for a consultation or request an appointment today.

Dr. Carlson’s office is located at the Duke Eye Center at 2351 Erwin Rd. in Durham, North Carolina.

See Dr. Carlson’s bio, including background, training, and accomplishments.

Meet Dr. Carlson

  • Over 52,500 successful surgeries
  • Over 135 medical publications
  • Over 350 international lectures
  • 2 time APPI Crystal award winner
  • Professor of Ophthalmology at Duke
  • 21 years voted best Doctors in America
  • Former Chief of Corneal and Refractive Surgery, Duke University Medical Center

Physician Referrals

Referrals from physicians and eye care professionals alike are welcomed and we are happy to assist with the care of your patients.

Call the office at (919) 684-5769 or fill out our appointment request form.

Thank you.

Latest Insights from the Carlson Blog

152017

Sutureless PDEK Triple Procedure

July 15th, 2017|

Corneal Transplantation has undergone several advances over the past 2 decades.  From full thickness penetrating keratoplasty (PK) to Deep Lamellar Endothelial Keratoplasty (DLEK – Dr. Mark Terry), Descemet’s Membrane Endothelial Keratoplasty (DSEK – Drs. Garrett Melles and Frank Price), DSAEK (“A” for Automated – Dr. Mark Gorovoy), Descemet’s Membrane Endothelial Keratoplasty (DMEK – Drs. Garrett Melles and Frank Price) and now, Pre-descemet’s Endothelial Keratoplasty […]

282017

Corneal Transplantation: Transitioning to PDEK (Pre-Descemet’s Endothelial Keratoplasty)

May 28th, 2017|

Corneal Transplantation has undergone several advances over the past 2 decades.  From full thickness penetrating keratoplasty (PK) to Deep Lamellar Endothelial Keratoplasty (DLEK – Dr. Mark Terry), Descemet’s Membrane Endothelial Keratoplasty (DSEK – Drs. Garrett Melles and Frank Price), DSAEK (“A” for Automated – Dr. Mark Gorovoy), Descemet’s Membrane Endothelial Keratoplasty (DMEK – Drs. Garrett Melles and Frank Price) and now, Pre-descemet’s Endothelial Keratoplasty […]

52017

Are you anxious about cataract surgery?

March 5th, 2017|

Cataract surgery, understandably causes anxiety to anyone needing or considering this procedure.  Patients hear “there is nothing to it” but every patient knows that there are potential problems.  If there were not potential problems, they would not need to undergo and sign an “informed consent.”  My patient offers a HIPAA-compliant and Social Media-compliant in-depth analysis of her care at Duke Eye Center in Durham, […]