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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.
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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).
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.
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.
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.
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