Technique for preparation of the corneal endothelium-Descemet membrane complex for transplantation.
OBJECTIVE
Replacing diseased corneal endothelium with a preparation of Descemet membrane carrying functional endothelium and no stroma may be a feasible method for treating corneal endothelial decompensation. To obtain a viable donor of a Descemet membrane endothelium disc, we modified the Descemet membrane stripping technique and monitored the percentage of endothelial damage to the donor tissue preparation.


METHODS
Forty-eight human corneas were used. Cornea buttons were mounted on an artificial anterior chamber, endothelial side up. Endothelia were stained with alizarin red, examined under the microscope, and photographed at 5 different sites (microscope, x100; digital magnification, x2.83). A 6 x 7-mm rectangular piece of endothelium-Descemet membrane complex was obtained using a Grieshaber microsurgical knife and Kelman-McPherson forceps. Digital photographs of endothelia were analyzed with a computer, and the percentage of endothelial damage was calculated. Specimens were processed for hematoxylin-eosin staining.


RESULTS
Forty of 48 endothelium-Descemet membrane preparations (83.3%) were complete peels with minimal endothelial damage. Endothelial damage before and after the surgery was 1.57 +/- 2.11% and 2.61 +/- 1.77%, respectively. Eight preparations (16.7%) failed because of tearing. Multiple hematoxylin-eosin-stained sections showed the presence of endothelium with intact Descemet membrane and no stromal tissue.


CONCLUSIONS
We modified the technique of Melles and obtained a sheet of Descemet membrane and endothelium with minimal endothelial damage and with no remaining stroma observed. This simple technique can be used to obtain the endothelium-Descemet membrane complex in minutes. It may be useful for corneal endothelium transplantation.
Zhu
Zejin
Z
Doheny Eye Institute, Los Angeles, CA 90033, USA.
Rife
Lawrence
L
Yiu
Samuel
S
Trousdale
Melvin D
MD
Wasilewski
Daniel
D
Siqueira
Alexandre
A
Smith
Ronald E
RE
D000328:Adult; D000368:Aged; D000880:Anthraquinones; D016039:Corneal Transplantation; D003886:Descemet Membrane; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009926:Organ Preservation; D013194:Staining and Labeling / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000379:methods*
D000880:Anthraquinones; C010078:alizarin