Splitting of the Recipient's Descemet Membrane in Descemet Membrane Endothelial Keratoplasty-Ultrastructure and Clinical Relevance.
OBJECTIVE
In Descemet membrane endothelial keratoplasty (DMEK), lamellar splitting of the Descemet membrane (DM) may occur during stripping of host DM, leaving residual DM on the recipient's DMEK interface. The purpose of this study was to determine the incidence rate of lamellar splitting of DM during DMEK and to describe the ultrastructure of DM in these eyes.


METHODS
Retrospective consecutive case series.


METHODS
setting: Institutional, single-center.


METHODS
Total of 664 eyes with Fuchs endothelial corneal dystrophy (FECD) scheduled for primary DMEK.


METHODS
DMEK.


METHODS
The incidence rate of lamellar DM splitting in the recipients' eyes; ultrastructural alterations of stripped DM specimens (transmission electron microscopy); preoperative best-corrected visual acuity (BCVA), central corneal thickness (CCT), and prevalence of diabetes mellitus.


RESULTS
Sixty-three of 664 eyes (9.5%) with FECD showed lamellar splitting of DM resulting in the dissociation of 2 separate layers. Transmission electron microscopy revealed accumulations of banded and wide-spaced collagen between the thicker posterior banded layer and the thin anterior banded layer, which is adhesive to the corneal stroma. Lamellar splitting occurred along these abnormal collagen inclusions, demarcating the borderline between both layers of DM.


CONCLUSIONS
Lamellar DM splitting occurs during DM stripping in almost 10% of eyes with FECD. This phenomenon appears to be caused by abnormal collagenous material deposits at the borderline between anterior and posterior layers of DM.
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. Electronic address: julia.weller@uk-erlangen.de.
Julia M
JM
Weller
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Ursula
U
Schlötzer-Schrehardt
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Friedrich E
FE
Kruse
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Theofilos
T
Tourtas
D000368:Aged; D002452:Cell Count; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000648:ultrastructure*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D012189:Retrospective Studies; D066027:Transplant Recipients; D014792:Visual Acuity