Stromal support for Descemet's membrane endothelial keratoplasty.

Abstract

To evaluate the use of a peripheral stromal support to facilitate and improve the outcomes of Descemet's membrane endothelial keratoplasty (DMEK). Prospective case series. Ten patients with Fuchs' endothelial dystrophy. Pneumatic dissection was used to detach the central part of the Descemet's membrane and endothelium from the deep stroma. Endothelial grafts including a peripheral stromal support were obtained by eccentric punching of donor tissue and used to perform DMEK surgery in 10 patients. Operative time, graft attachment rate, best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, refraction, and complications. In all cases the surgical time was ≤ 1 hour. The postoperative course was uneventful in all but 2 cases, which required rebubbling owing to early graft detachment. Final attachment rate was 100%. The average follow-up was 8.4 months (range, 6-12). Postoperative BSCVA was ≥ 20/40 in all cases and no substantial change in refraction was recorded. Postoperative endothelial cell loss averaged 24.1% (range, 8%-34.9%). Stromal support facilitates surgery, reduces complications, and appears to maintain the favorable outcomes of DMEK.