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Bjoern Bachmann, Ursula Schlotzer-Schrehardt, Martin Boergel, Friedrich Kruse; Clinical Evaluation of a Novel Method to Generate Precut Tissue for Descemet Membrane Endothelial Keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2013;54(15):1678.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet Membrane Endothelial Keratoplasty (DMEK) is a novel procedure for transplantation of corneal endothelium resulting in unsurpassed improvement of postoperative visual acuity. A central issue regarding this technique is the complexity of graft preparation which hinders its wide spread use. Therefore, the evaluation of precut tissue for DMEK is essential for making this technique amenable to a larger group of surgeons.
Precut preparation of organ cultured donor corneas was preformed as previously described resulting in incompletely stripped Descemet’s membranes where the central part was still attached to the corneal stroma. Subsequent culture for up to 5 days was followed by the use of the precut grafts for DMEK in patients with Fuchs’ endothelial dystrophy. Visual acuity, central corneal thickness (Pentacam®, Oculus) and endothelial cell density (CellCheck XLTM, Konan) were retrospectively analyzed during the early postoperative period.
Stripping was successfully completed in all grafts directly prior to surgery. The average visual acuity (logMAR) improved from 0.49 +/- 0.13 preoperatively to 0.23 +/- 0.12 one month after DMEK. Central preoperative corneal thickness decreased from 667 +/- 31µm preoperatively to 555 +/- 60 µm at 1 week and 484 +/- 8 µm 4 weeks after DMEK. Average endothelial cell density was 2496 +/- 271 cells /mm2 before and 2275 +/- 247 cells/mm2 3 days after precut preparation (2 days before DMEK). One month after DMEK endothelial cell density further decreased to 1817 +/- 111 cell/mm2.
Precut preparation of DMEK tissue, generated by incomplete Descemet stripping, leads to minor endothelial cell loss during subsequent culture. The use of precut tissue for DMEK results in a fast visual recovery, only minor additional endothelial cell loss and a rapid decrease of corneal thickness.
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