[0:04]I am Dr. Ofer Dafna, from Ion Medical, the inventor of the EndoArt. It is my honor to present to you the EndoArt, a corneal artificial endothelial layer. The EndoArt has demonstrated both safety and efficacy in humans. The EndoArt is a revolutionary device, the answer to global shortage of corneal allographs. It also eliminates the possibility of implant rejection. The EndoArt is implanted just like Dsec and Dmac. It's dome-shaped, it's biocompatible, it's resilient, and made from acrylic material. So unlike human tissue, you can actually touch it. This, of course, makes the operation much easier. When the EndoArt is attached to the posterior part of the cornea, it becomes a barrier to aqueous humor. This decreases corneal thickness and corneal edema. Today, I'm going to show you the implantation of the EndoArt step by step. The procedure here is performed by Dr. Sunita Charasia from LV Prasad India. Before insertion of the implant, we have four steps. First, I recommend removing any loose epithelium from the cornea to create better visualization of the anterior chamber. Step two, create a primary 2.4 mm incision. Then, the secondary ports for maintainer and reverse Sinsky hook. Based on your DMEC preferences, you may consider creating the primary incision after performing the descemetorhexis. The third step is marking a central 7 to 7.5 mm circle to mark the border of the descemetorhexis. The descemetorhexis should not be too large to prevent a formation of gap between the implant edge and the peripheral endothelium. This could result in post-op peripheral bullae. Remember that any overlap between the implant and the remaining endothelium could promote detachment. The descemetorhexis may be accomplished under anterior chamber maintainer. Nevertheless, at the end of the descemetorhexis, I recommend to use either air bubble or vision blue in order to see better any endothelial remnants. Once you remove the endothelium, create a potent inferior iridectomy at 6 o'clock. Now the eye is prepared for implantation. We begin with insertion of the implant and end with implant secured in place. The orientation of the implant is important. Use the F-letter mark to make sure you have the right orientation. Use a blunt spatula to insert the implant through the primary incision. This technique gives you control of implant orientation during insertion. The implant is resilient and can be touched without damaging it. After insertion of the implant, inject a small air bubble beneath the implant. Center the implant with direct manipulation or by stroking the surface of the cornea. Now, check again the F sign for correct orientation. In the next step, suture the main incision. To avoid air leakage, I recommend suturing the side port as well. Then, make an air gas exchange with 10% per flouropropane.
[3:54]I recommend filling 80% of the anterior chamber with per flouropropane. It's crucial to have a sufficient gas size bubble with good margins beyond the edge of the implant. This creates surface tension, which is the first step of attachment. It's crucial that the bubble should not be too large to prevent pupillary block in case of a high ocular pressure. Post-op, avoid deflating the chamber. Any sudden drop in ocular pressure could lead to detachment of the implant. Suture the implant at exactly 12 o'clock, passing once through the implant. Make sure the needle passes from beneath the implant towards the stroma as you see in the drawing. After suturing, make sure there are no bubbles or fluid in the interface. Massage the cornea from the suture to the periphery. Deformation of small droplets on the posterior surface of the implant is a natural phenomenon. Interfacial fluid on the other hand need to be removed by massage. This is the end of the operation. The post-op is as important for success as the operation itself. The patient should remain in the OR in supine position with open eyelids for 20 minutes. This is important to promote corneal drying. Then apply therapeutic contact lens, steroids and antibiotic drops. In the recovery room, the patient should remain in supine position for at least another four hours. In the four days following the procedure, instruct your patient to lie on their back at home as much as possible. This will maximize the success of the procedure. As you now saw, the procedure is quick and simple. I invite you to consider the EndoArt for your next endothelial keratoplasty. And good luck from the Ion team.
