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E. B. Price, T. John, K. R. Kenyon; Light and Electron Microscopic Analysis of Excised Human Descemet’s Membrane Following Descemetorhexis With Endokeratoplasty. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2197.
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To evaluate the efficacy of descemetorhexis and Descemet’s stripping at producing a smooth recipient stromal surface in the context of descemetorhexis with endokeratoplasty (Descemet’s stripping automated endothelial keratoplasty, DSAEK).
Twenty-eight posterior lamellar recipient corneal samples were obtained from 27 DSAEK patients through descemetorhexis and Descemet’s stripping with the John dexatome. Two samples from normal human donor eyes were also obtained as controls. All samples were examined using light microscopy and a representative sample was examined with transmission electron microscopy. All samples were evaluated for the presence of residual corneal stroma and the thickness of Descemet’s membrane (DM). Patient samples were also scored for the number of DM excrescences (guttata) per high power field.
Histopathologic examination of all samples revealed no residual corneal stroma. The mean (SD) thickness of the DM was 18.09 (6.99) µm in the patient group and 11.27 (2.90) µm in the normal controls, with no statistical difference between groups (P = 0.19). Patient samples with smooth DM had a mean (SD) thickness of 14.27 (2.70) µm, while those with DM excrescences averaged 21.40 (7.93) µm thick. This difference was statistically significant (P < 0.01). When the level of excrescences on the visual rating scale was compared between the two groups, the ranked mean (SD) of the excrescences samples (n = 15) was 3.33 (0.82), versus 1 (0) for the smooth samples (n = 13). This difference was also statistically significant (P < 0.01).
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