Descemet’s Membrane Exposure in Full Bed by a Technique of Viscoelastic Injection through a Pocket for Deep Lamellar Keratoplasty

Abstract

Abstract: : Purpose: To develop a technique of Descemet’s Membrane exposure in the entire stromal bed for deep lamellar keratoplasty and report our preliminary result. Methods: The Descemet’s membrane of the recipient cornea was initially exposed in a small area by a fine forceps tooth at 12 o’clock around the trephined wound margin. A beveled 27-gauge canula was inserted between Descemet’s membrane and stroma, and viscoelastic material was injected to fully detach Desecemet’s membrane from the deep stromal layer in the entire bed. The recipient stroma in full thickness without Desecemet’s membrane was removed around the trephined margin. A cryopreserved donor corneal button was grafted to the bed. Results: Sixteen eyes of 16 patients with clouded cornea and normal endothelial function received this surgery. Among them, Desecemet’s membrane was exposed in the entire bed in 15 eyes (93.7%), but in one eye (6.3%) a Desecemet’s membrane hole was made during scissors removal of recipient corneal stroma. Cryopreserved donor corneal button was successfully grafted in 15 eyes with intact Desecemet’s membrane exposure, but fresh donor cornea was grafted to the Desecemet’s membrane perforated eye. The mean surgical time of 15 eyes was 67±13 min. Epithelialization of the corneal graft was completed within 5 days in all 15 eyes. The donor corneal stromal edema was resolved in 30 days and corneal transparency restored in all 15 eyes. Three months or more later, the mean visual acuity without correction was 20/49 and the mean best corrected visual acuity was 20/29. Conclusions: This technique enables adequate and reliable exposure of Desecemet’s membrane in the entire bed to simplify deep lamellar keratopasty with ease. Cyropreseved donor cornea without healthy endothelium is usable to restore the corneal clarity and remarkably enhance visual acuity when combined with this type of deep lamellar keratoplasty.

Keywords: cornea: clinical science • transplantation • visual acuity