title: Patterns of corneal endothelialization and corneal clearance after descemet membrane endothelial keratoplasty for fuchs endothelial dystrophy.
abstract: OBJECTIVE
  To describe various endothelial migration healing patterns after Descemet membrane endothelial keratoplasty (DMEK), and to determine the contribution of the donor and host endothelium in the clearance of a transplanted cornea.
  
  
  METHODS
  Nonrandomized, prospective clinical study.
  
  
  METHODS
  In a total of 150 consecutive eyes that underwent DMEK (ie, transplantation of an isolated Descemet graft, for Fuchs endothelial dystrophy), re-endothelialization patterns were studied. Of these eyes, 36 showed a "stromal gap" between the "descemetorhexis edge" and the graft, or (partial) graft detachment. Endothelialization patterns of the host posterior stroma were documented at 1, 3, 6, 9, 12, and 24 months after surgery with Pentacam imaging, specular microscopy, optical coherence tomography, confocal microscopy, and slit-lamp biomicroscopy.
  
  
  RESULTS
  Complete corneal clearance was seen in 28 of 36 eyes (78%) with a stromal gap, or (partial) detachment, progressing from the periphery toward the center; and 27 of 34 eyes (79%) with normal visual potential reached a visual acuity of ≥20/40 (≥0.5) or better. In 3 eyes that had the Descemet graft implanted upside-down, a "reversed corneal clearance pattern" was observed (ie, persistent edema where the graft was attached), while the area overlying the detachment cleared. One case that had a "descemetorhexis" performed without endothelial graft implantation showed persistent stromal edema.
  
  
  CONCLUSIONS
  The presence of donor endothelium in the recipient anterior chamber may be required for endothelial migration and/or recovery of corneal clarity. Re-endothelialization may be associated with massive endothelial migration and some form of cell signaling to draw donor endothelial cells toward the recipient posterior stroma ("homing").
authors: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
authors: Martin
authors: M
authors: Dirisamer
authors: Isabel
authors: I
authors: Dapena
authors: Lisanne
authors: L
authors: Ham
authors: Korine
authors: K
authors: van Dijk
authors: Oganesyan
authors: O
authors: Oganes
authors: Laurence E
authors: LE
authors: Frank
authors: Jacqueline
authors: J
authors: van der Wees
authors: Gerrit R J
authors: GR
authors: Melles
mesh_terms: D002452:Cell Count; D002465:Cell Movement / Q000502:physiology*; D003315:Cornea / Q000502:physiology*; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000166:cytology*; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018613:Microscopy, Confocal; D011446:Prospective Studies; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology*