title: Posterior lamellar keratoplasty using descemetorhexis and organ-cultured donor corneal tissue (Melles technique).
abstract: OBJECTIVE
  To report the clinical results of posterior lamellar keratoplasty (PLK) using predissected organ-cultured donor corneal tissue implanted after stripping of the Descemet membrane.
  
  
  METHODS
  Twenty-two eyes of 22 patients in whom a PLK procedure was performed for pseudophakic bullous keratopathy and/or Fuchs endothelial dystrophy were evaluated. In all eyes, the recipient Descemet membrane was excised by performing a descemetorhexis. Just after harvesting the donor tissue, each cornea had a posterior lamellar dissection made at approximately 80% stromal depth, and each cornea was preserved in an organ culture system for 10 to 21 days. During surgery, a posterior lamellar disk was trephinated from the predissected donor cornea and inserted through a 5.0-mm scleral incision into the anterior chamber of the recipient by folding the donor. Specular microscopy was performed at 6, 12, and 18 months to measure the endothelial cell density.
  
  
  RESULTS
  In 3 eyes (14%), the posterior donor disk did not attach to the recipient posterior stroma, so a penetrating keratoplasty was performed in a secondary procedure. The transplants in the remaining 19 eyes cleared and maintained clarity throughout the follow-up period. In these eyes, best corrected visual acuity (BCVA) ranged from 0.25 to 1.0 up to 27 months of follow-up. Postoperative astigmatism averaged 1.7 +/- 1.0 D. Endothelial cell density averaged 1650 +/- 390 cells/mm at 6 months, 1560 +/- 350 cells/mm at 12 months, and 1500 +/- 430 cells/mm at 24 months. Two eyes developed mild interface haze.
  
  
  CONCLUSIONS
  PLK can be performed using an organ-cultured donor posterior disk. Visual rehabilitation may be slower than in PLK with fresh donor tissue.
authors.affiliation: Department of Ophthalmology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Carla P
authors.initials: CP
authors.lastname: Nieuwendaal
authors.forename: Ruth
authors.initials: R
authors.lastname: Lapid-Gortzak
authors.forename: Ivanka J
authors.initials: IJ
authors.lastname: van der Meulen
authors.forename: Gerrit J R
authors.initials: GJ
authors.lastname: Melles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D016039:Corneal Transplantation / Q000379:methods*; D015925:Cryopreservation; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000601:surgery*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques; D014019:Tissue Donors; D014021:Tissue Preservation; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology