June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Reproducibility of graft preparations in Descemet membrane endothelial keratoplasty
Author Affiliations & Notes
  • Kathrin Rössler
    Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
  • Ursula Schlotzer-Schrehardt
    Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
  • Bjoern Bachmann
    Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
  • Friedrich Kruse
    Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3086. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Kathrin Rössler, Ursula Schlotzer-Schrehardt, Bjoern Bachmann, Friedrich Kruse; Reproducibility of graft preparations in Descemet membrane endothelial keratoplasty. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3086.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose: To assess the reproducibility of manual graft preparation and to evaluate the incidence rate and nature of structural anomalies of Descemet’s membrane (DM) preventing successful graft preparation in Descemet membrane endothelial keratoplasty (DMEK).

Methods: In a prospective single-center nonrandomized consecutive case series, 350 corneoscleral buttons from donors aged 18 to 95 years stored in Optisol™-GS or Dulbecco's Modified Eagle’s Medium were used for DMEK surgery in 343 consecutive patients with Fuchs’ endothelial dystrophy. Residual endothelial cell-DM-complexes obtained after successful DM stripping for DMEK and whole donor corneas obtained after unsuccessful DM stripping were examined by transmission electron microscopy and immunohistochemistry.

Results: Uneventful manual separation of DM resulting in a regular and smooth cleavage plane was achieved in 335/350 (95.7%) of donor corneas by use of a previously established bimanual submerged preparation technique. Although 8/350 (2.3%) of donor corneas showed focal adhesions of DM to the corneal stroma and developed isolated tears during stripping, preparation of the graft could be successfully completed. However, 7/350 (2.0%) of donor corneas showed extremely strong adhesion and multiple tears of DM preventing successful preparation of the graft. These specimens revealed either ultrastructural (peg-like interlockings) or biochemical abnormalities (increased staining intensities for adhesive glycoproteins) along the DM-stroma interface.

Conclusions: Using an appropriate technique, manual preparation of grafts for DMEK with reproducible tissue qualities is possible in the vast majority of donor corneas. Tissue loss rate can be reduced to about 2% of donor corneas, but cannot be eliminated completely due to interindividual structural and biochemical aberrations of the DM-stroma interface preventing DM stripping and graft preparation.

Keywords: 481 cornea: endothelium • 741 transplantation  
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×