Novel technique for the preparation of corneal grafts for descemet membrane endothelial keratoplasty.
OBJECTIVE
To report a simple novel technique to facilitate preparation of Descemet membrane grafts for Descemet membrane endothelial keratoplasty (DMEK).


METHODS
Laboratory investigation and retrospective, single-center, consecutive case series.


METHODS
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.


RESULTS
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.


CONCLUSIONS
We report here a reliable and efficient technique for the preparation of pure Descemet membrane grafts.
Department of Ophthalmology, Charles Nicolle Hospital, Rouen, France. Electronic address: Marc.Muraine@chu-rouen.fr.
Marc
M
Muraine
Julie
J
Gueudry
Zhiguo
Z
He
Simone
S
Piselli
Sabine
S
Lefevre
David
D
Toubeau
D000368:Aged; D002387:Cataract Extraction; D002452:Cell Count; D002470:Cell Survival; D003886:Descemet Membrane / Q000648:ultrastructure; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000166:cytology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology