Novel technique for the preparation of corneal grafts for descemet membrane endothelial keratoplasty.

Abstract

To report a simple novel technique to facilitate preparation of Descemet membrane grafts for Descemet membrane endothelial keratoplasty (DMEK). Laboratory investigation and retrospective, single-center, consecutive case series. Preparation of the endothelial graft is performed on an artificial anterior chamber, endothelial side up. After an incomplete circular superficial trephination, we describe a simple technique using a 27 gauge cannula to detach the Descemet membrane (DM). Endothelial cell density (ECD) was measured before dissection on 12 human corneas for research and 3 days after storage in organ culture. Histologic and electron microscopy analysis were performed. A DMEK was performed in 50 patients with Fuchs dystrophy. Visual acuity and ECD were evaluated 2 and 6 months after surgery. ECD was 2765 ± 256 cells/mm(2) on corneas for research before dissection and 2651 ± 305 cells/mm(2) after 3 days in organ culture (P < .01). Histologic and electronic sections confirm that the cleavage was between DM and posterior stroma. Clinically, preparation of 2 corneas from a single donor was unsuccessful; 48 corneas were clear at 2 months and 47 at 6 months. At 2 months 77% of the patients had recovered a visual acuity of at least 20/30. At 6 months, 91.5% of the patients had a visual acuity of at least 20/30. ECD was 2656 ± 28 cells/mm(2) (range: 2450-3100 cells/mm(2)) preoperatively, 1797 ± 41 cells/mm(2) (range: 1100-2700 cells/mm(2)) at 2 months, and 1658 ± 43 cells/mm(2) (range: 900-2600 cells/mm(2)) at 6 months. We report here a reliable and efficient technique for the preparation of pure Descemet membrane grafts.