Transplantation of Descemet’s membrane with endothelium by continuous curvilinear descemetorhexis (CCD)

Abstract

Abstract: : Purpose: To show a new technique to perform corneal endothelial transplantation. Methods: Japanese white rabbits (2 kg body weight) and human eyebank eyes were used as donors and recipients of Descemet’s membrane transplantation. All animals were treated according to the ARVO Statement for the Use of Animals in Ophthalmology and Vision Research. Donor rabbits were sacrificed by an overdose of pentobarbital, and enucleated for tissue processing. Similar surgical procedures were performed in both rabbtis and eyebank eyes. Donor endothelium was hidrodissected by injecting indocyanine green from a limbal incision, and then processed as a corneal scleral button. A 6 mm diameter donor sheet was trephined, and folded in half using a 6 mm diameter polymer as a carrier. Recipient endothelium was also hydrodissected from the limbus using trypan blue to stain the Descemet’s membrane. Following injection of viscomaterial into the anterior chamber, a continuous curvilienar descemetorhexis (CCD) was performed to remove a circular section of the Descemet’s membrane using a 27G cystotome. Donor tissue was inserted into the anterior chamber through a 5 mm limbal incision and appositioned to the host stroma. Polymers were removed following transplantation. Control animals were operated by CCD alone without transplantation of donor endothelium. Results: All control eyes demonstrated stromal edema due to partial loss of Descemet’s membrane, while eyes with Descemet’s transplantation had clear corneas. Average pachymetry of operated eyes was 376.6 ± 32.5 µm compared to 389.6 ± 25.1 µm in the unoperated eye. Control eyes were too edematous for pachymetry readings. Average endothelial density immediately following surgery in eyebank eyes was 2651±187 /mm². Conclusions:Transplantation of Descemet’s membrane with endothelium is feasible by combining hydrodissection of Descemet’s membrane with CCD.

Keywords: cornea: endothelium • cornea: clinical science • transplantation