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Javier Cabrerizo, Clara Rodriguez Aierbe; Electron microscopy assessment of Descemet membrane interphase during DMEK graft preparation.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1201.
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© 2017 Association for Research in Vision and Ophthalmology.
Graft preparation remains a challenging step of Descemet membrane endothelial keratoplasty (DMEK). Needing a learning curve itself, it adds surgical complexity to DMEK when compared with other techniques and may prevent the fast adoption of the technique by some groups. The aim of our study is to determine morphological microscopical characteristics of Descemet membrane interphase during Descemet membrane endothelial keratoplasty (DMEK) graft preparation.
Five corneas, not eligible for clinical use were used in our study. DMEK graft preparation with specific set of instruments (Dorc, Scheijdelveweg, The Netherlands) was performed until the line of detachment reached the equator of the inner corneal curvature. The detached membrane was folded backwards, to enable a clear Descemet-stroma interphase, and the tissue was prepared for transmission electron microscopy (Hitachi S-4800, Tokyo, Japan).The interphase was geographically categorized in central, mid-peripheral and peripheral. Images were taken in different areas of the interphase and morphological findings were classified in three categories, minor fibrotic adhesions, mayor bridge-like adhesions, and stromal ruptures.
Differences in number and morphology of stroma-Descemet adhesions were found between different areas of the Descemet membrane. Fibrotic linear adhesions were predominant in the center and mid periphery while larger bridge-like adhesions were predominantly found in the periphery. Correlation between the size of those adhesions and the presence of ruptures in the underlying stromal bed was found.
Electron microscopy characterization of stromal-Descemet interphase shows morphological differences between central and peripheral areas of potential clinical relevance during DMEK preparation. Those differences may explain tissue behavior during graft preparation. A better understanding of the characteristics and prevalence of those adhesions may contribute for a more successful DMEK graft preparation.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Peripheral Descemet-stroma interphase with several bridge-like adhesions.
Close image of a bridge-like adhesion with underlying stromal rupture.
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