Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S).
OBJECTIVE
To describe a novel technique for the preparation and transplantation of posterior corneal lamellae consisting of endothelium and bare Descemet membrane with a stromal supporting rim.


METHODS
Posterior lamellar discs for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) were prepared manually immediately before surgery using the big bubble technique. The retrospective case series that underwent DMEK-S comprised 20 eyes of 18 patients with endothelial dysfunction. Best-corrected visual acuity (BCVA) and endothelial cell density (ECD) were measured preoperatively and 12-24 months after DMEK-S.


RESULTS
At the end of the follow-up, 10 out of 18 eyes achieved a BCVA of 1.0 or better, and 17 reached 0.5 or better. Primary graft failure occurred in two eyes. The average ECD at 1 year was 1608 (+/-503) cells/mm(2), that is, a mean cell loss from preoperative values of 44%. Partial early postoperative graft detachment (12 of 20 eyes) was treated by injecting an air bubble into the anterior chamber in all cases. The loss of donor corneas during preparation decreased from approximately 10 to 5% as more experience was acquired with the procedure.


CONCLUSIONS
Preliminary outcomes show that DMEK-S may be used in the treatment of corneal endothelial dysfunction. As this approach is entirely manual, and no special surgical equipment is needed, it has the potential to become widely adopted.
Department of Ophthalmology, Sokolov Hospital, Sokolov, Czech Republic. studenypavel@seznam.cz
Pavel
P
Studeny
Andrej
A
Farkas
Magdalena
M
Vokrojova
Petra
P
Liskova
Katerina
K
Jirsova
D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000601:surgery*; D003319:Corneal Stroma / Q000637:transplantation*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity