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C. Cursiefen, L. M. Heindl, B. O. Bachmann, F. E. Kruse; Split Donor Cornea Transplantation by Combined DMEK and DALK Surgeries: A New Strategy to Reduce Corneal Donor Shortage. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1618.
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To evaluate the feasibility of using a single donor cornea for two recipients by combining DMEK and DALK procedures on the same surgery day.
On 10 consecutive surgery days including 20 patients, first a patient with keratoconus was operated on using the big-bubble deep anterior lamellar keratoplasty (DALK) technique. When big-bubble formation and preparation to Descemet’s membrane was successful (and no conversion to penetrating keratoplasty was necessary), during surgery the donor Descemet’s membrane was removed for subsequent DMEK in a second patient. The remaining anterior donor cornea was used for the DALK recipient. Afterwards, a DMEK procedure was performed on the second patient with Fuchs endothelial dystrophy using the remaining Descemet with donor endothelium.
Consecutive scheduling of DALK and DMEK patients allows for combined dual use of donor tissue for both DALK and DMEK. DALK procedure has to be performed first, since at least initially there may be a need to use a full thickness graft in case of DALK conversion to penetrating keratoplasty (always one back-up donor cornea necessary). That regimen could be applied successfully in 16 of 20 initial patients. In four cases DALK had to be converted to penetrating keratoplasty and a new cornea had to be used for subsequent DMEK procedure. Thereby 40% of donor corneas were saved.
Split use of donor corneas for combined DALK and DMEK procedures on the same surgical day is a novel and promising tool to reduce donor shortage in corneal transplantation.
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